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YALE UNIVERSITY 
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A HISTORY 



OF 



EPIDEMICS IN BRITAIN 



ILonDon: C. J. CLAY and SONS, 

CAMBRIDGE UNIVERSITY PRESS WAREHOUSE, 

AVE MARIA LANE. 

AND 

H. K. LEV^IS, 
136, GOWER STREET, W.C. 




(ITambritiSC : DEIGHTON, BELL AND CO. 

ILeipjig: F. A. BROCKHAUS. 

i^cia Sorfe: MACMILLAN AND CO. 



A HISTORY 



OF 



EPIDEMICS IN BRITAIN 



BY 



CHARLES CREIGHTON, M.A., M.D., 

FORMERLY DEMONSTRATOR OF ANATOMY IN THE UNIVERSITY OF CAMBRIDGE. 



VOLUME II. 

From the Extinction of Plague to the present time. 



CAMBRIDGE: 
AT THE UNIVERSITY PRESS. 

1894 

[AH Rights reserved. '\ 



Camfaritip : 

PRINTED BY C. J. CLAY, M.A. AND SONS, 
AT THE UNIVERSITY PRESS. 






PREFACE. 



THIS volume is the continuation of 'A History of Epidemics 
in Britain from A.D. 664 to the Extinction of Plague ' 
(which was published three years ago), and is the completion of 
the history to the present time. The two volumes may be 
referred to conveniently as the first and second of a ' History of 
Epidemics in Britain.' In adhering to the plan of a systematic 
history instead of annals I have encountered more difficulties 
in the second volume than in the first. In the earlier period the 
predominant infection was Plague, which was not only of so 
uniform a type as to give no trouble, in the nosological sense, but 
was often so dramatic in its occasions and so enormous in its 
effects as to make a fitting historical theme. With its disappear- 
ance after 1666, the field is seen after a time to be occupied by 
a numerous brood of fevers, anginas and other infections, which 
are not always easy to identify according to modern definitions, 
and were recorded by writers of the time, for example Wintring- 
ham, in so dry or abstract a manner and with so little of human 
interest as to make but tedious reading in an almost obsolete 
phraseology. Descriptions of the fevers of those times, under 
the various names of synochics, synocha, nervous, putrid, miliary, 
remittent, comatose, and the like, have been introduced into the 
chapter on Continued Fevers so as to show their generic as well 
as their differential character ; but a not less important purpose 
of the chapter has been to illustrate the condition of the working 
classes, the unwholesomeness of towns, London in particular, the 
state of the gaols and of the navy, the seasons of dearth, the 
C. II. b 



vi Preface. 

times of war-prices or of depressed trade, and all other vicissi- 
tudes of well-being, of which the amount of Typhus and Relapsing 
Fever has always been a curiously correct index. It is in this 
chapter that the epidemiology comes into closest contact with 
social and economic history. In the special chapter for Ireland 
the association is so close, and so uniform over a long period, 
that the history may seem at times to lose its distinctively 
medical character. 

As the two first chapters are pervaded by social and economic 
history, so each of the others will be found to have one or more 
points of distinctive interest besides the strictly professional. 
Smallpox is perhaps the most suitable of all the subjects in this 
volume to be exhibited in a continuous view, from the epidemics 
of it in London in the first Stuart reigns to the statistics of last 
year. While it shares with Plague the merit, from a historical 
point of view, of being always the same definite item in the bills 
of mortality, it can be shown to have experienced, in the course 
of two centuries and a half, changes in its incidence upon the 
classes in the community, upon the several age-periods and upon 
town and country, as well as a very marked change relatively 
to measles and scarlatina among the infective scourges of infancy 
and childhood. For certain reasons Smallpox has been the most 
favoured infectious disease, having claimed an altogether dis- 
proportionate share of interest at one time with Inoculation, at 
another time with Vaccination. The history of the former practice, 
which is the precedent for, or source of, a whole new ambitious 
scheme of prophylaxis in the infectious diseases of men and brutes, 
has been given minutely. The latter practice, which is a radical 
innovation inasmuch as it affects to prevent one disease by the 
inoculation of another, has been assigned as much space in the 
chapter on Smallpox as it seems to me to deserve. Measles and 
Whooping-cough are historically interesting, in that they seem 
to have become relatively more prominent among the infantile 
causes of death in proportion as the public health has improved. 
Whooping-cough is now left to head the list of its class by the 
shrinkage of the others. It is in the statistics of Measles and 



Preface. vii 

Whooping-cough that the principle of population comes most 
into view. The scientific interest of Scarlatina and Diphtheria 
is mainly that of new, or at least very intermittent, species. 
Towards the middle of the i8th century there emerges an 
epidemic sickness new to that age, in which were probably 
contained the two modern types of Scarlet Fever and Diphtheria 
more or less clearly differentiated. The subsequent history of 
each has been remarkable: for a whole generation Scarlatina could 
prove itself a mild infection causing relatively few deaths, to 
become in the generation next following the greatest scourge of 
childhood ; for two whole generations Diphtheria had disappeared 
from the observation of all but a few medical men, to emerge 
suddenly in its modern form about the years 1856-59. 

The history of Dysentery, as told by the younger Heberden, 
has been a favourite instance of the steady decrease of a disease 
in London during the 18th century. I have shown the error in 
this, and at the same time have proved from the London bills of 
mortality of the 17th and i8th centuries that Infantile Diarrhoea, 
which is now one of the most important causes of death in some 
of the great manufacturing and shipping towns, was formerly 
still more deadly to the infancy of the capital in a hot summer 
or autumn. Asiatic Cholera brings us back, at the end of the 
history, to the same great problem which the Black Death of 
the 14th century raised near the beginning of it, namely, the 
importation of the seeds of pestilence from some remote country, 
and their dependence for vitality or effectiveness in the new soil 
upon certain favouring conditions, which sanitary science has 
now happily in its power to withhold. I have left Influenza to 
be mentioned last. Its place is indeed unique among epidemic 
diseases ; it is the oldest and most obdurate of all the problems 
in epidemiology. The only piece of speculation in this volume 
will be found in the five-and-twenty pages which follow the 
narrative of the various historical Influenzas ; it is purely 
tentative, exhibiting rather the disjecta nie^nbra of a theory than 
a compact and finished hypothesis. If there is any new light 
thrown upon the subject, or new point of view opened, it is in 



viii Preface. 

bringing forward in the same context the strangely neglected 
history of Epidemic Agues. 

Other subjects than those which occupy the nine chapters of 
this volume might have been brought into a history of epidemics, 
such as Mumps, Chickenpox and German Measles, Sibbens and 
Button Scurvy, together with certain ordinary maladies which 
become epidemical at times, such as Pneumonia, Erysipelas, 
Quinsy, Jaundice, Boils and some skin-diseases. While none of 
these are without pathological interest, they do not lend them- 
selves readily to the plan of this book ; they could hardly have 
been included except in an appendix of miscellanea airiosa, and 
I have preferred to leave them out altogether. It has been 
found necessary, also, to discontinue the history of Yellow Fever 
in the West Indian and North American colonies, which was 
begun in the former volume. 

I have, unfortunately for my own labour, very few acknow- 
ledgements to make of help from the writings of earlier workers 
in the same field. My chief obligation is to the late Dr 
Murchison's historical introduction to his 'Continued Fevers of 
Great Britain.' I ought also to mention Dr Robert Willan's 
summary of the throat-distempers of the i8th century, in his 
'Cutaneous Diseases' of 1808, and the miscellaneous extracts 
relating to Irish epidemics which are appended in a chrono- 
logical table to Sir W. R. Wilde's report as Census Commissioner 
for Ireland. For the more recent history, much use has 
naturally been made of the medical reports compiled for the 
public service, especially the statistical. 



September, 1 894. 



CONTENTS. 

CHAPTER I. 

TYPHUS AND OTHER CONTINUED FEVERS. 

PAGE 

The Epidemic Fever of 1661, according to Willis .... 4 

Sydenham's epidemic Constitutions ....... 9 

Typhus Fever perennial in London . 13 

The Epidemic Constitutions following the Great Plague . . 17 

The Epidemic Fever of 1685-86 22 

Retrospect of the great Fever of 1623-25 30 

The extinction of Plague in Britain 34 

Fevers to the end of the 17th Century 43 

Fevers of the seven ill years in Scotland 47 

The London Fever of 1709-10 54 

Prosperity of Britain, 1715-65 60 

The Epidemic Fevers of 1718-19 ....... 63 

The Epidemic Fevers of 1726-29: evidence of Relapsing Fever . 66 

The Epidemic Fever of 1741-42 ....... 78 

Sanitarv Condition of London under George II 84 

The W'indow-Tax 88 

Gaol-Fever 90 

Circumstances of severe and mild Typhus 98 

Ship-Fever 102 

Fever and Dysentery of Campaigns : War Typhus, 1742-63 . . 107 

Ship-Fever in the Seven Years' War and American War . . 11 1 
The "Putrid Constitution" of Fevers in the middle third of the 

1 8th Century 120 

Miliary Fever 128 

Typhus Fever in London, 1770-1800 133 

Typhus in Liverpool, Newcastle and Chester in the last quarter 

of the I 8th century . . ...... 140 

Fever in the Northern Manufacturing Towns, 1 770-1 800 . . 144 
Typhus in England and Scotland generally, in the end of the 

i8th century 151 

Fevers in the Dearth of 1 799-1 802 159 

Comparative immunity from Fevers during the War and high 

prices of 1803-15. . . 162 

The Distress and Epidemic Fever (Relapsing) following the Peace 

of 1815 and the fall of wages ....... 167 

The Epidemic of 18 17-19 in Scotland : Relapsing Fever . . 174 

The Relapsing Fever of 1827-28 . 181 

Typhoid or Enteric Fever in London, 1826 183 

Return of Spotted Typhus after 1831 : "Change of Type." Distress 

of the Working Class . • . 188 

Enteric Fever mixed with the prevailing Typhus, 1831-42 . . 198 

Relapsing Fever in Scotland, 1842-44 203 



Contents. 



The "Irish Fever" of 1847 in England and Scotland . . . 205 

Subsequent Epidemics of Typhus and Relapsing Fevers . . 208 

Relative prevalence of Typhus and Enteric Fevers since 1869 . 211 

Circumstances of Enteric Fever . . . . • . . 216 

CHAPTER 11. 

FEVER AND DYSENTERY IN IRELAND. 

Dysentery and Fever at Londonderry and Dundalk, 1689 . . 229 

A generation of Fevers in Cork 234 

Famine and Fevers in Ireland in 17 18 and 1728 .... 236 

The Famine and Fever of 1740-41 240 

The Epidemic Fevers of 1799-1801 248 

The Growth of Population in Ireland ...... 250 

The Famine and Fevers of 181 7-18 256 

Famine and Fever in the West of Ireland, 1821-22 . . . 268 

Dysentery and Relapsing Fever, 1826-27 271 

Perennial Distress and Fever 274 

The Great Famine and Epidemic Sicknesses of 1846-49 . . 279 

Decrease of Typhus and Dysentery after 1849 .... 295 

CHAPTER HI. 

INFLUENZAS AND EPIDEMIC AGUES. 

Retrospect of Influenzas and Epidemic Agues in the i6th and 

17th centuries 306 

The Ague-Curers of the 17th Century 315 

The Peruvian Bark Controversy . . . . . . . 320 

The Influenza of 1675 326 

The Influenza of 1679 328 

The Epidemic Agues of 1678-80 329 

The Influenza of 1688 335 

The Influenza of 1693 337 

The Influenza of 1712 339 

Epidemic Agues and Influenzas, 1727-29 . . . . . 341 

The Influenza of 1733 . 346 

The Influenza of 1737 348 

The Influenza of 1743 349 

Some Localized Influenzas and Horse-colds . . . . . 352 

The Influenza of 1762 356 

The Influenza of 1767 358 

The Influenza of 1775 . 359 

The Influenza of 1782 362 

The Epidemic Agues of 1780-85 366 

The Influenza of 1788 '370 

The Influenza of 1803 374 

The Influenza of 1 831 379 

The Influenza of 1833 380 

The Influenza of 1837 383 

The Influenza of 1847-48 389 

The Influenzas of 1889-94 393 

The Theory of Influenza 398 

Influenza at Sea 425 

The Influenzas of Remote Islands 431 



Contents. xi 
CHAPTER IV. 

SMALLPOX. 

PAGE 

Retrospect of earlier epidemics 434 

Smallpox after the Restoration . 437 

Sydenham's Practice in Smallpox . . . . . . . 445 

Causes of Mild or Severe Smallpox 450 

Pockmarked Faces in the 17th Century 453 

The Epidemiology continued to the end of the 17th century . 456 

Smallpox in London in 1694: the death of the Queen . . . 458 

Circumstances of the great Epidemic in 1710 461 

Inoculation brought into England 463 

The popular Origins of Inoculation 471 

Results of the first Inoculations ; the Controversy in England . 477 

Revival of Inoculation in 1740 : a New Method .... 489 

The Suttonian Inoculation 495 

Extent of Inoculation in Britain to the end of the 18th Century . 504 

The Epidemiology continued from 1721 517 

Smallpox in London in the middle of the i8th century . . 529 

The Epidemiology continued to the end of the i8th century . 535 

The range of severity in Smallpox, and its circumstances . . 544 

Cowpox 557 

Chronology of epidemics resumed from 1801 567 

The Smallpox Epidemic of 1817-19 571 

Extent of Inoculation with Cowpox or Smallpox, 1801-1825 . . 582 

The Smallpox Epidemic of 1825-26 593 

A generation of Smallpox in Glasgow 597 

Smallpox in Ireland, 1830-40 601 

The Epidemic of 1837-40 in England ...... 604 

Legislation for Smallpox after the Epidemic of 1837-40 . . 606 

Other effects of the epidemic of 1837-40 on medical opinion . 610 

The age-incidence of Smallpox in various periods of history . 622 



CHAPTER V. 

MEASLES. 

Derivation and early uses of the name 632 

Sydenham's description of Measles in London, 1670 and 1674 . 635 

Measles in the i8th century 641 

Increasing mortality from Measles at the end of the i8th century 647 

Measles in Glasgow in 1808 and 1811-12: Researches of Watt . 652 

Measles in the Period of Statistics 660 



CHAPTER VI. 

WHOOPING-COUGH. 

Earliest references to whooping-cough 666 

Whooping-cough in Modern Times . 671 

Whooping-cough as a Sequel of other Maladies .... 674 



Xll 



Contents, 



CHAPTER VII. 



SCARLATINA AND DIPHTHERIA. 



Nosological difficulties in the earlier history .... 
The Throat-distemper of New England, 1735-36 . 

Angina maligna in England from 1739 

An epidemic of Throat-disease in Ireland, 1743 

Malignant Sore-throat in Cornwall, 1748 .... 

Fothergill's Sore-throat with Ulcers, 1746-48 .... 

"Scarlet Fever" at St Albans, 1748 

Epidemics of Sore-throat with Scarlet rash in the period between 

Fothergill and Withering ....... 

Scarlatina anginosa in its modern form, 1777-78 . 
History of Scarlatina after the Epidemic of 1778 . 
Scarlatina (1788) and Diphtheria (1793-94) described by the same 

observer 

Scarlatinal Epidemics, 1796-1805 

Scarlatina since the beginning of Registration, 1837 

Reappearance of Diphtheria in 1856-59 

Conditions favouring Diphtheria 



CHAPTER VHI. 



INFANTILE DIARRHOEA, CHOLERA NOSTRAS, AND DYSENTERY. 



Summer Diarrhoea of Infants in London, 17th century . 
Summer Diarrhoea of Infants, i8th century . 
Modern Statistics of Infantile Diarrhoea .... 
Causes of the high Death-rates from Infantile Diarrhoea 

Cholera Nostras 

Dysentery in the 17th and i8th centuries 

Dysentery in the 19th century 



CHAPTER IX. 



ASIATIC CHOLERA. 



Asiatic Cholera at Sunderland in October, 1831 

Extension of Cholera to the Tyne, December, 1831 

The Cholera of 1832 in Scotland 

The Cholera of 1832 in Ireland 

The Cholera of 1832 in England 

The Cholera of 1848-49 in Scotland 

The Cholera of 1849 i" Ireland 

The Cholera of 1849 ii^ England . • j • 

The Cholera of 1853 at Newcastle and Gateshead 

The Cholera of 1854 in England 

The Cholera of 1853-54 in Scotland and Ireland 

The Cholera of 1865-66 

The Antecedents of Epidemic Cholera in India 
Note on Cerebro-Spinal Fever . 



CHAPTER I. 

TYPHUS AND OTHER CONTINUED FEVERS. 

It was remarked by Dr James Lind, in 1761, that a 
judicious synopsis of the writings on fevers, in a chronological 
sense, would be a valuable book : it would bring to light, he 
was fain to expect, treasures of knowledge ; " and perhaps the 
influence of a favourite opinion, or of a preconceived fancy, 
on the writings of some even of our best instructors, such as 
Sydenham and Morton, would more clearly be perceived ^" 
Lind himself was the person to have delivered such a history 
and criticism. He was near enough to the 17th century writers 
on fevers to have entered correctly into their points of view ; 
while so far as concerned the detection of theoretical bias or 
preconceived fancies, he had shown himself a master of the art 
in his famous satire upon the " scorbutic constitution," a verbal 
or mythical construction which had been in great vogue for 
a century and a half, and was still current, at the moment when 
Lind destroyed it, in the writings of Boerhaave and Haller. 
A judicious historical view of the English writings on fevers, 
such as this i8th century critic desired to see, may now be 
thought superfluous. The theories, the indications for treatment, 
the medical terms, have passed away and become the mere 
objects of a learned curiosity. But the actual history of the old 
fevers, of their kinds, their epidemic prevalence, their incidence 
upon rich or poor, upon children or adults, their fatality, their 
contagiousness, their connexion with the seasons and other 
vicissitudes of the people — all this is something more than 
curious. 

' James Lind, M.D., Tivo Papers on Fevers and Infection. Lond. 1763, p. 79. 
C. II. I 



2 Typhus a7id other Continued Fevers. 

Unfortunately for the historian of diseases, he has to look 
for the realities amidst the "favourite opinions" or the "precon- 
ceived fancies" of contemporary medical writers. Statements 
which at first sight appear to be observations of matters of fact 
are found to be merely the necessary truths or verbal construc- 
tions of some doctrine. One great doctrine of the 17th and 
1 8th centuries was that of obstructions: in this doctrine, as 
applied to fevers, obstructions of the mesentery were made of 
central importance ; the obstructions of the mesentery extended 
to its lymphatic glands ; so that we come at length, in a mere 
theoretical inference, to something not unlike the real morbid 
anatomy of enteric fever. Another great doctrine of the time, 
specially applied by Willis to fevers, was that of fermentations 
and acrimonies. " This ferment," says a Lyons disciple of 
Willis in 1682, "has its seat in the glandules of the velvet 
coat of the stomach and intestines described by Monsieur 
Payers" But the Lyons physician is writing all the while 
of the fevers that have always been common in the Dombes 
and Bresse, namely intermittents ; the tertian, double tertian, 
quotidian, quartan, or double quartan paroxysm arises, he says, 
from the coagulation of the humours by the ferment which has 
its seat in the glandules described by M. Payer, even as acids 
cause a coagulation in milk, the paroxysm of ague continuing, 
" until this sharp chyle be dissipated and driven out by the 
sweat or insensible perspiration." The lymphatic follicles of the 
intestine known by the name of Payer, or Peyer, were then 
the latest anatomical and physiological novelty, and were 
chosen, on theoretical grounds, as the seat of fermentation or 
febrile action in agues. On the ground of actual observation 
they were found about a century and a half after to be the seat 
of morbid action in typhoid fever. 

While there are such pitfalls for the historian in identifying 
the several species of fevers in former times, there are other 
difficulties of interpretation which concern the varieties of a 
continued fever, or its changes of type from generation to 
generation. Is change of type a reality or a fiction .■* And, if a 
reality, did it depend at all upon the use or abuse of a certain 
regimen or treatment, such as blooding and lowering, or heating 
and corroborating ? A pupil of CuUen, who wrote his thesis in 

^ Ol'scrvations on Fevers and Felirijiiges. Made Englisli from the Frencli of M. 
Sijon. London, 1682. 



Changing CJim^acters of Fevers. 3 

1782 upon the interesting topic of the change in fevers since the 
time of Sydenham^, inferred that the great physician of the 
Restoration could not have had to treat the low, putrid or 
nervous fevers of the middle and latter part of the i8th century, 
otherwise he would not have resorted so regularly to blood- 
letting, a practice which was out of vogue in continued fevers at 
the time when the thesis was written, as well as for a good many 
years before and after. Fevers, it was argued, had undergone 
a radical change since the time of Sydenham, in correspondence 
with many changes in diet, beverages and creature comforts, 
such as the greatly increased use of tea, coffee and tobacco, and 
of potatoes or other vegetables in the diet, changes also in the 
proportion of urban to rural population, in the use of carriages, 
and in many other things incident to the progressive softening 
of manners. In due time the low, putrid, nervous type of typhus 
fever, which is so much in evidence in the second half of the 
1 8th century, ceased to be recorded, an inflammatory type, or a 
fever of strong reaction, taking its place ; so that Bateman, 
of London, writing in 1818, said : "The putrid pestilential fevers 
of the preceding age have been succeeded by the milder forms 
of infectious fever which we now witness " ; while Armstrong, 
Clutterbuck, and others, who had revived the practice of blood- 
letting in fevers shortly before the epidemic of 18 17-18, claimed 
the comparatively slight fatality and short duration of the 
common fever of the time as an effect of the treatment. After 
1 83 1, typhus again became low, depressed, spotted, not admitting 
of the lancet ; on which occasion the doctrine of " change of 
type" was debated in the form that the older generation of 
practitioners still remember. 

Thus the task of the historian, whose first duty is to ascertain, 
if he can, the actual matters of fact, or the realities, in their 
sequence or chronological order, is made especially difficult, 
in the chapter on continued fevers, by the contemporary in- 
fluence of theoretical pathology or " a preconceived fancy," by the 
ascription of modifying effects to treatment, whether cooling or 
heating, lowering or supporting, and, most of all, by the absence 
of that more exact method which distinguishes the records 
of fever in our own time. Nor can it be said that the work 
of historical research has been made easier in all respects, by the 

^ James Hutchinson, M.D., De Miitatione Febriwn e tempore Sydcnhami, etc. 
Edin. 1782. Thesis. 

I — 2 



4 Typhus and other Continued Fevers. ' 

exact discrimination and perfected diagnosis to which we are 
accustomed in present-day fevers. In the years between 1840 
and 1850, the three grand types of fever then existing in Britain, 
namely, spotted typhus, enteric, and relapsing fever, were at 
length so clearly distinguished, defined and described that 
no one remained in doubt or confusion. Thereupon arose the 
presumption that these had always been the forms of continued 
fever in Britain, and that the same fevers, presumably in the 
same relative proportions to each other, might have been left 
on record by the physicians of former generations, if they 
had used the modern exactness and minuteness in observing 
both clinical history and anatomical state, which were seen 
at their best in Sir William Jenner. It would simplify history, 
indeed it would make history superfluous, if that were really the 
case. There are many reasons for believing that it was not the 
case. As Sydenham looked forward to his successors having 
experiences that he never had, so we may credit Sydenham with 
having really seen things which we never see, not even those of 
us who saw the last epidemics of relapsing fever and typhus. 
It is due to him, and to his contemporaries and nearest 
successors, to reciprocate the spirit in which he concludes the 
general chapter on epidemics prefatory to his annual constitu- 
tions from 1661 to 1676: 

" I am far from taking upon myself the credit of exhausting my subject 
in the present observations. It is highly probable that I may fail even in 
the full enumeration of the epidemics. Still less do I warrant that the 
diseases which during the years in question have succeeded each other 
in the sequence about to be exhibited shall remain the same in all future 
years. One thing most especially do I aim at. It is my wish to state how 
things have gone lately ; how they have been in this country, and how they 
have been in this the city which we live in. The observations of some 
years form my ground-work. It is thus that I would add my mite, such as 
it is, towards the foundation of a work that, in my humble judgment, shall be 
beneficial to the human race. Posterity will complete it, since to them it 
shall be given to take the full view of the whole cycle of epidemics in their 
mutual sequences for years yet to come^." 

The epidemic fever of 1661, according to W^illis. 

On the very threshold of the period at which the history is 
resumed in this volume, we find a minute account by Willis of 
an epidemic in the year 1661, which at once raises the question 
whether a certain species of infectious fever did really exist at 

^ ObseiTatioves Mcdicae, .^rd ed. 1676, i. 2. § 23. Englisli 1)y R. G. T.atlinm, M.D. 



Willis on the Epidemic of i66i. 5 

that time which exists no longer, or whether Willis described as 
" a fever of the brain and nervous stock " what we now call 
enteric fever. Willis's fever corresponds in every respect to the 
worm fever, the comatose fever, the remittent fever of children, 
the acute fever with dumbness, the convulsive fever, which was 
often recorded by the medical annalists and other systematic 
observers as late as the beginning of the 19th century\ It 
ceased at length to be recorded or described, and it has been 
supposed that it was really the infantile or children's part of 
enteric fever, which had occurred in former times as now^ 
The epidemic fever which Willis saw in the summer of 1661, 
after a clear interval of two years from the great epidemics of 
agues, with influenzas, in 1657-59, is called by him "a certain 
irregular and unaccustomed fever^" It was not, however, new 
to him altogether ; for he had seen the same type, and kept 
notes of the cases, in a particular household at Oxford in 1655, 
as well as on other occasions. It was an epidemical fever 
" chiefly infestous to the brain and nervous stock." It raged 
mostly among children and youths, and was wont to affect them 
with a long and, as it were, a chronical sickness. When it 
attacked the old or middle-aged, which was more rarely, it did 
sooner and more certainly kill. It ran through whole families, 
not only in Oxford and the neighbouring parts, "but in the 
countries at a great distance, as I heard from physicians dwelling 
in other places." Among those other witnesses, we shall call 
Sydenham ; but meanwhile let us hear Willis, whose account is 
the fullest and least warped by theory. 

Its approach was insidious and scarce perceived, with no immoderate 
heat or sharp thirst, but producing at length great debihty and languishing, 
loss of appetite and loathing. Within eight days there were brain symptoms — 
heavy vertigo, tingling of the ears, often great tumult and perturbation of the 
brain. Instead of phrensy, there might be deep stupidity or insensibility ; 
children lay sometimes a whole month without taking any notice of the 
bystanders, and with an involuntary flux of their excrements ; or there might 
be frequent delirium, and constantly absurd and incongruous chimaeras in 
their sleep. But in men a fury, and often-times deadly phrensy, did 
succeed. If, however, neither stupidity nor great distraction did fall upon 
them, swimmings in the head, convulsive movements, with convulsions of the 

^ Reports ofWhitehaven Dispensary (Dixon) and of Nottingham General Hospital 
(Clarke), cited in the sequel. 

'■^ Rilliet, Be la Fievre Typhoide chez les Enfanis, These, Paris, 2 Janv. 1840, 
based on 6i cases; West, Diseases of Infancy and Childhood, 3rd ed. Lond. 1854. 

•* " Febris epidemicae cerebro et nervoso generi potissimum infestae, anno 1661 
increbescentis descriptio,"in Pathologia Cerebri, Cap. viii, "De Spasmis universalibus 
qui in febribus malignis " etc., Eng. transl. p. 51. 



6 Typhtts and otJier Continued Fevers. 

members and leaping up of the tendons did grievously infest them. In almost 
all, there were loose and stinking motions, now yellow, now thin and serous ; 
vomiting was unusual ; the urine deep red. The sufferers in this prolonged 
sickness wasted to a skeleton, with no great heat or evacuations to account 
for the wasting. Some, at the end of the disease, had a severe catarrh. In 
others, with little infection of the head, soon after the beginning of the 
fever a cruel cough and a stinking spittle, with a consumptive disposition, 
grew upon them, and seemed to throw them suddenly into a phthisis, from 
which, however, they recovered often beyond hope. In some there were 
swellings of the glands near the hinder part of the neck, which ripened and 
broke, and gave out a thin stinking ictor for a long time. " I have also seen 
watery pustules excited in other parts of the body, which passed into hollow 
ulcers, and hardly curable. Sometimes little spots and petechiales appeared 
here and there." But none of the spots were broad and livid, nor were there 
many malignant spots. 

Willis then gives several cases clinically, in his usual manner. The first 
is of a strong and lively young man, who was sick above two months and 
seemed near death, but began to mend and took six weeks to recover, 
sweating every night or every other night of his convalescent period. The 
second case, aged twelve, was restored to health in a month. Numbers 
three and four were children of a nobleman, who both died, the convulsive 
type being strongly marked ; one of the two was examined after death, and 
found to have several sections of the small intestine telescoped, but all the 
abdominal viscera free from disease^, the lungs engorged, the vessels of the 
brain full, much water in the sub-arachnoid space, and more than half 
a pint in the lateral ventricles. 

In farther illustration of this type of fever, epidemic in 1661, Willis goes 
back to his notes of a sporadic outbreak of what he thinks was the same 
disease in a certain family at Oxford in the winter of 1653-4- : " yea I 
remember that sometime past very many laboured with such a fever." In 
the family in question, five children took the fever one after another during 
a space of four months, two of the cases proving fatal ; the domestics also took 
it, and some strangers who came in to help them, " the evil being propagated 
by contagion." The cases in the children are fully recorded^, the following 
being some of the symptoms : 

In case i, aged seven, the illness began at the end of December, 1653 (or 
1655): there were contractions of the wrist tendons, red spots like flea-bites 
on his neck and other parts, drowsiness, and involuntary passage of the 
excrements. At the end of a fortnight, a flux set in and lasted for four 
days ; next, after that, a whitish crust or scurf, as it were chalky, began to 
spread over the whole cavity of his mouth and throat, which being often in 
a day wiped away, presently broke forth anew. He mended a little, but had 
paralysis of his throat and pharynx, was reduced to a living skeleton, but at 
length got well. 

Case 2, a brother, aged nine, had frequent loose and highly putrid 
motions on the eleventh day ; and next day, the flux having ceased, the 
most severe colic, so that he lay crying out day and night, his belly swollen 
and hard as a drum, until, on the 24th day, he died in an agony of 
convulsions. 

Case 3, a brother, aged 11, was taken with similar symptoms on the 13th 
February, and died on the 13th day. 



' " Itaciuc ventrcm inferiorem primo apericns, viscera omnia in eo contenta satis 
sana et sarte tecta inveni " — the small intestine being telescoped in several places. 

- Elsewhere he says the first case of the series was " circa solstitium liyemale anno 

>655-" 

•' J)e Fdiribus, chapter " De febriinis pestilentilnis." 



Infantile Remittent Fever. 7 

Case 4, a sister, was taken ill in March, with less marked symptoms, 
and recovered slowly, having had no manifest crisis. 

Case 5, a boy of the same family, and the youngest, fell ill about the 
same time as No. 4, and after the like manner, " who yet, a looseness 
arising naturally of itself, for many days voiding choleric and greenish stuff, 
was easily cured." 

Then comes a general reference to the domestics and visitors, who fell 
sick of the same and all recovered. 

The prolonged series of cases in the household of this 
" venerable man " appears to have made a great impression upon 
Willis, as something new in his experience, as well as in the 
experience of several other physicians who gave their services. 
That it was malignant he considers proved " ex contagio, 
pernicie, macularum pulicularum apparentia, multisque aliis 
indiciis." He adds that he had seen the same disease spora- 
dically at other times ; and again " I remember that formerly 
several laboured under such a fever." Those cases were all 
previous to the general prevalence of the fever which he identifies 
with them in the summer of 1661, under the name of a " fever of 
the brain and spinal cord." 

The signs given by Willis are as nearly as may be the signs 
of infantile remittent fever, or worm fever, or febris synochus 
puerorum, or hectica infantilis, or febris lenta infantum, or an 
acute fever with dumbness, of which perhaps the first systematic 
account in this country was given by Dr William Butter of 
Lower Grosvenor Street, in 1782 \ It is, he says, both a 
sporadical and an epidemical disease, "and when epidemical it is 
also contagious." The age for it is from birth up to puberty ; 
but "similar symptoms are often observed in the disorders of 
adults." Morton, writing in 1692-94, clearly points to the same 
fever under the name of worm fever (febris verminosa). He 
adds it at the very end of his scheme of fevers, as if in an 
appendix, having been unable to find a place for it in any of his 
categories owing to its varying forms — hectic, acute, intermittent, 
continued, avve'xfj'i, inflammatory, but for the most part colli- 
quative or o-vvo-)(o<i, " and malignant according to the varying 
degrees of the venomous miasm causing it I" Butter also recog- 
nizes its varying types : it has many symptoms, but they seldom 
all occur in the same case ; there are three main varieties — the 
acute, lasting from eight to ten days up to two or three weeks ; 

1 Treatise on the Infantile Remittent Fever. London, 1782. 

2 Pyretologia, 1 vols. Lond. 1692 — 94, i. 68, at the end of " Synopsis Febrium " :— 
"Febris verminosa, quae nulli e specibus memoratis praecise determinari potest." 



8 Typhus and other Continued Fevers. 

the slow, lasting two or three months ; and the low, lasting a 
month or six weeks. The slow form, he says, is only sporadic ; 
the low is only epidemic, and is never seen but when the acute is 
also epidemical ; it is rare in comparison with the latter, and 
not observed at all except in certain of the epidemical seasons. 
Waiving the question whether the remittent fever of children, 
thus systematically described, was not a composite group of 
maladies, of which enteric fever of children was one, we can 
hardly doubt that Willis found a distinctive uniform type in the 
epidemic of 1661, in Oxford as be saw it himself, in other parts 
of England by report. It had symptoms which were not quite 
clearly those of enteric fever : spots, like fleabites, on the neck 
and other parts, swelling and suppuration of the glands in the 
hinder part of the neck, effusion of fluid on the brain and in the 
lateral ventricles, and the intestine free from disease \ 

Confirming Willis's account for Oxford, is the case of Roger 
North, when a boy at Bury St Edmunds Free School in 1661, 
as related by himself in his ' Autobiography ^' Being then 
" very young and small," after a year at school he had " an 
acute fever, which endangered a consumption." Elsewhere he 
attributes his bad memory with "confusion and disorder of 
thought," to that " cruel fit of sickness I had when young, 
wherein, I am told, life was despaired of, and it was thought 
part of me was dead ; and I can recollect that warm cloths 
were applied, which could be for no other reason, because I had 
not gripes which commonly calls for that application." That 
"great violence of nature," while it had impaired his mental 
faculties, had sapped his bodily vigour somewhat also, of which 
he gives a singular illustration. 

This special prevalence of epidemic fevers in the summer and 
autumn of 1661 is noticed also by the London diarists. 

Evelyn says that the autumn of 1661 was exceedingly sickly 
and wet^ Pepys has several entries of fever^ On 2 July, 166 1 : 
" Mr Saml. Crewe died of the spotted fever." On 16 August : 
" At the [Navy] Office all the morning, though little to do ; 

' llfiser gives a reference to an essay in which Willis's fever of 1661 is compared 
lu enteric fever : C. M. W. Rietschel, Epidemia anni 1661 a Willisio et fcbris nervosa 
lenta ah Ihixliamio descriptae, etc. cum typJio abdoniiuali nostra tempore obvio 
coiiiparantur. Lips. 1861. Not having found this essay, I cannot say on what 
grounds the comparison is made. 

- Lives of the Norths. New ed. by Jessopp. 3 vols. 1890, iii. 8, 21. 

* Diary of John Evelyn, Esq., F.R.S., 1641 — 1706, under the date of 18 Sept. 

•* Diary of Samuel Pepys, Esq., F.R..S., 1659 — 69. 



The London Fever of i66i. 9 

because all our clerks are gone to the burial of Tom Whitton, 
one of our Controller's clerks, a very ingenious and a likely- 
young man to live as any in the office. But it is sue h a sickly 
time both in the city and country everywhere (of a sort of fever) 
that never was heard of almost, unless it was in a plague-time. 
Among others the famous Tom Fuller [of the ' Worthies of 
England '] is dead of it ; and Dr Nichols [Nicholas], Dean of 
St Paul's ; and my Lord General Monk is very dangerously ill." 
On 3 1 August : " The season very sickly everywhere of strange 
and fatal fevers." On 15 January, 1662: "Hitherto summer 
weather, both as to warmth and every other thing, just as if it 
were the middle of May or June, which do threaten a plague (as 
all men think) to follow ; for so it was almost the last winter, and 
the whole year after hath been a very sickly time to this day." 

The great medical authority of the time is Sydenham. His 
accounts of the seasons and reigning diseases of London extend 
from 1 66 1 to 1686, so that they begin with the year for which 
Willis described the epidemic fever " chiefly infestous to the 
brain and nervous stock," popularly called the new disease. 
But Sydenham did not describe the epidemic in the same 
objective way that Willis did. He records a series of " epidemic 
constitutions of the air," the particular constitution of each year 
being named from the epidemic malady that seemed to him to 
dominate it most. It was, perhaps, because it had to conform 
to Sydenham's " preconceived fancy," as Lind said, that his 
account of the dominant type of fever in 1661 differs somewhat 
from that given by Willis. 

Sydenham's epidemic Constitutions. 

Sydenham adopted the epidemic constitutions from Hippo- 
crates, as he did much else in his method and practice. In the 
first and third books of the ' Epidemics,' Hippocrates describes 
three successive seasons and their reigning diseases in the island 
of Thasos, as well as a fourth plague-constitution which agrees 
exactly with the facts of the plague of Athens as described by 
Thucydides. The Greek term translated " constitution " is 
Kardaraai^, which means literally a settling, appointing; or- 
daining, and in the epidemiological sense means the type of 
reigning disease as settled by the season. The method of 
Hippocrates is first to give an account of the weather — the winds, 



lO 



Typhus and other Contiimed Fevers. 



the rains, the temperature and the like, — and then to describe 
the diseases of the seasons \ Sydenham followed his model 
with remarkable closeness. The great plague of London has 
almost the same place in his series of years that the plague- 
constitution, the fourth in order, has in that of Hippocrates. It 
looks, indeed, as if Sydenham had begun with the year 1661, 
more for the purpose of having several constitutions preceding 
that of the plague than because he had any full observations of 
his own to record previous to 1665. He is also much influenced 
by the example of Hippocrates in giving prominence to the 
intermittent type of fevers. It was remarked by one of our best 
1 8th century epidemiologists, Rogers of Cork, and with special 
reference to Sydenham's " intermittent constitutions," that fevers 
proper to the climate of Thasos were not likely to be identified 
in or near London excepted by a forced construction. 





Sydenhams 


Constitutio7is. 












Total 




Fever and 


Small- 




Griping 




Constitutions 


deaths in 


! Plague 


Spotted 


Measles 


in the 






London 




Fever 


pox 


' 


Guts 


t66i 


"Intermittent" con- 


16,665 


20 


3.490 


1,246 


188 


1,061 


1662 


stitution: with a con- 


i3'664 


12 


2,601 


768 


20 


835 


1663 


tinued fever through- 


12,741 


9 


2,107 


411 


42 


866 


1664 


out. 


i5'453 


5 


2,258 


1.233 


311 


1,146 


166^ 


Constitution of plague 


97.306 


, 68,596 


5.257 


655 


7 


1,288 


1666 


and pestilential fever. 


12,738 


, 1.998 


741 


38 


3 


676 


1667 


Constitution of small- 


15,842 


35 


916 


1,196 


83 


2, to8 


1668 


pox, with a continued 


17.278 


1 14 


1,247 


1.987 


200 


2,415 


1669 


"variolous " fever. 














1669 


Constitution of dysen- 


j 19.432 


3 


1.499 


951 


15 


4,385 


1670 


tery and cholera nostras, 


20,198 





1.729 


1.465 


295 


3.690 


1671 


with a continued fever. 


15.729 


5 


1.343 


696 


17 


2,537 


1672 


Measles in 1670. 


18,230 


5 


1,615 


1,116 


118 


2,645 


1673 


Constitution of "co- 


17.504 


5 


1,804 


853 


15 


2,624 


1674 


matose" fevers. 


21,201 


3 


2,164 


2.507 


795 


1,777 


1675 
1676 


Influenza in 1675. 


17.244 

18,732 


2 


2.154 
2,112 


997 

359 


I 
83 


3.321 
2,083 


1677 


Not recorded. 


19,067 


2 


1.749 


1,678 


87 


2,602 


1678 


Return of the "inter- 


20,678 


5 


2.376 


1.798 


93 


3.150 


1679 


mittent" constitution, 


21,730 


2 


2.763 


1,967 


117 


2,996 


1680 


absent since 1661-64. 


21,053 





3.324 


689 


49 


3,271 


i68i 
1682 
1683 


" Depuratory" fevers, 
or dregs of the inter- 
mittents. 


23.95' 
20,691 
20,587 







3.174 
2,696 
2,250 


2,982 
1,408 
2,096 


121 

50 
39 


2,827 
2,6:51 
2,438 


1684 


23,202 





2,836 


1,560 


6 


2,981 


r685 


Constitution of a 


23,222 





3,832 


2,496 


197 


2,203 


1686 


' ' new " continued fever. 


22,609 





4.185 


1,062 


25 


2,605 



' An analysis of the four Hippocratic constitutions, with modern illustrative cases, 
is given hy Alfred Ilaviland, Climate, Weather, and Disease. London, 1855. 



Sydenham s account of the 1661 Fever. ii 

The foregoing is a Table of Sydenham's epidemic constitu- 
tions from 1 66 1 to 1686, compiled from his various writings, 
with the corresponding statistics from the London Bills of 
Mortality. 

I give this Table both as a convenient outline and in 
deference to the great name of Sydenham. But we should be 
much at fault in interpreting the figures of the London Bills, or 
the history of epidemic diseases in the country at large, if we 
had no other sources of information than his writings. Only 
some of the figures in the Table concern us in this chapter ; 
plague has been finished in the previous volume, smallpox, 
measles and " griping in the guts " are reserved each for a 
separate chapter, as well as the influenzas and epidemic agues 
which formed the chief part of the " strange " or " new " fevers. 
If this work had been the Annals of Epidemics in Britain, it 
would have been at once proper and easy to follow Sydenham's 
constitutions exactly, and to group under each year the 
information collected from all sources about all epidemic 
maladies. But as the work is a history, it proceeds, as other 
histories do, in sections, observing the chronological order and 
the mutual relations of epidemic types as far as possible ; and 
in this section of it we have to cull out and reduce to order the 
facts relating to fevers, beginning with those of 1661. 

Cases of fever, says Sydenham, began to be epidemic about 
the beginning of July 1661, being mostly tertians of a bad type, 
and became so frequent day by day that in August they were 
raging everywhere, and in many places made a great slaughter 
of people, whole families being seized. This was not an ordinary 
tertian intermittent ; indeed no one but Sydenham calls it an 
intermittent at all, and he qualifies the intermittence as follows : 

" Autumnal intermittents do not at once assume the genuine type, but in 
all i-espects so imitate continued fevers that unless you examine the two 
respectively with the closest scrutiny, they cannot be distinguished. But, 
when by degrees the impetus of the ' constitution ' is repelled and its 
strength reined in, the fevers change int.o a regular type ; and as autumn 
goes out, they openly confess themselves, by casting their slough {larva 
abjectd) to be the intermittents that they really were from the first, whether 
quartans or tertians. If we do not attend to this diligently" etc. And 
again, in a paragraph which does not occur in the earlier editions, he 
writes as follows in the context of the " Intermittent Fevers of the years 
1661-1664:" 

" It is also to be noted that in the beginning of intermittent fevers, 
especially those that are epidemic in autumn, it is not altogether easy to 
distinguish the type correctly within the first few days of their accession, 
since they arise at first with continued fever superadded. Nor is it always 



12 Typhus and other Continued Fevers. 

easy, unless you are intent upon it, to detect anything else than a slight 
remission of the disease, which, however, declines by degrees into a perfect 
intermission, with its type (third-day or fourth-day) corresponding fitly to the 
season of the year." 

The intermittent character of these fevers seems to have 
struck Sydenham himself in a later work as forced and unreal. 
Writing in 1680, when the same kind of fevers were prevalent, 
after the epidemic agues of 1678 and 1679, he calls them 
" depuratory," and says that " doubtless those depuratory fevers 
which reigned in 1661-64 were as if the dregs of the intermittents 
which raged sometime before during a series of years," i.e. the 
agues of i657-59\ 

Theory or names apart, Sydenham's account of the fatal 
epidemic fever of the summer and autumn of 1661, comes to 
nearly the same as Willis's. Without saying expressly, as 
Willis does, that the victims were mostly children or young 
people, he speaks in one place of those of more mature years 
lying much longer in the fever, even to three months, and he 
specially mentions the same sequelae of the fever in children 
that Willis mentions, and that Roger North remembered in his 
own case — namely that they sometimes became hectic, with 
bellies distended and hard, and often acquired a cough and 
other consumptive symptoms, " which clearly put one in mind of 
rickets." He refers also to pain and swelling of the tonsils and 
to difficulty of swallowing, which, if followed by hoarseness, 
hollow eyes, and the fades Hippocratica, portended speedy 
death. Among the numerous other accidentia of the fever, was 
a certain kind of mania. Among the symptoms were phrensy, 
and coma-vigil ; diarrhoea occurred in some owing, as he thought, 
to the omission of an emetic at the outset ; hiccup and bleeding 
at the nose were occasional. 

But, although Sydenham must have had the same phenomena 
of fever before him that Willis had, the epidemic being general, 
according to the statements of both, one would hardly guess from 
his way of presenting the facts, that the fever was what Willis 
took it to be — a slow nervous fever, with convulsive and ataxic 
symptoms, specially affecting children and the young. Both 
Willis and Sydenham recognised something new in it; the 
common people called it, once more, the " new disease," and 
Pcpys calls it a " sort of fever," and " strange and fatal fevers." 

^ F.pht. I. Kcspons. § 57. Greenliill's ud. p. 2y8. 



The Queen's Fever, 1663. 13 

As Sydenham maintains that the same epidemic constitution 
continued until 1664 (although the fever-deaths in London are 
much fewer in 1662-3-4 than in the year 1661, which was the 
first of it), we may take in the same connexion Pepys's account 
of the Queen's attack of fever in 1663. The young princess 
Katharine of Portugal, married to Charles II. in 1662, had the 
beginning of a fever at Whitehall about the middle of October, 
1663 ; Pepys enters on the 19th that her pulse beat twenty to 
eleven of the king's, that her head was shaved, and pigeons put 
to her feet, that extreme unction was given her (the priests so 
long about it that the doctors were angry). On the 20th he 
hears that the queen's sickness is a spotted fever, that she was 
as full of the spots as a leopard : " which is very strange that it 
should be no more known, but perhaps it is not so." On the 
22nd the queen is worse, 23rd she slept, 24th she is in a good 
way to recovery. Sir Francis Prujean's cordial having given her 
rest; on the 26th " the delirium in her head continues still ; she 
talks idle, not by fits, but always, which in some lasts a week 
after so high a fever, in some more, and in some for ever." 
On the 27th she still raves and talks, especially about her 
imagined children ; on the 30th she continues " light-headed, but 
in hopes to recover." On 7th December, she is pretty well, 
and goes out of her chamber to her little chapel in the house ; 
on the 31st "the queen after a long and sore sickness is become 
well again." 

Typhus fever perennial in London. 

Sydenham says that a continued fever, the symptoms of 
which so far as he gives them suggest typhus, was mixed with 
the masked intermittent, (or the convulsive fever of children, as 
in Willis's account), in every one of the years 166 1-4; and that 
statement raises a question which may be dealt with here once 
for all. Fever in the London bills ■ is a steady item from year 
to year, seldom falling below a thousand deaths and in the year 
1741, during a general epidemic of typhus, rising to 7500. The 
fevers were a composite group, as we have seen, and shall see 
more clearly. But the bulk of them perennially appears to have 
been typhus fever. Where the name of " spotted fever " is given 
there can be little doubt. Every year the bills have a small 
number of deaths from " spotted fever," and the number of them 



14 TypJuis and other Continued Fevers. 

always rises in the weekly bills in proportion to the increase of 
"fever" in general, sometimes reaching twenty in the week 
when the other fevers reach a hundred. It would be a mistake 
to suppose that only the fevers called spotted were typhus, the 
other and larger part being something else. The more reason- 
able supposition is that the name of spotted was given by the 
searchers in cases where the spots, or vibices or petechiae of 
typhus were especially notable. If a score, or a dozen or half- 
a-dozen deaths in a week are set down to spotted fever, it 
probably means that a large part of the remaining hundred, or 
seventy, or fifty cases of " fever " not called spotted were really 
of the same kind, namely typhus. In the plague itself, the 
" tokens," which were of the same haemorrhagic nature as the 
larger or more defined spots of typhus, were exceedingly 
variable\ One of the synonyms of typhus (the common name 
in Germany) is spotted typhus ; but the spots were of at least 
two kinds, a dusky mottling of the skin and more definite spots, 
sometimes large, sometimes like fleabites. 

Assuming that the cases specially called "spotted" in the 
London Bills were only a part of all that might have been called 
by the same name in the wider acceptation of the term (as in 
Germany), it is a significant fact that there are few of the weekly 
bills for a long series of years in the 17th and i8th centuries 
without some of the former. Such a case as that of Mr Samuel 
Crewe, brother of Lord Crewe, who died of the "spotted fever" on 
2 July, 1661, probably means that there were more cases of the 
same kind in the poorer parts of the town, from which no account 
of the reigning sicknesses ever came unless it were the number 
of deaths in the bills. The conditions of endemic typhus were 
there long before we have authentic accounts, towards the end 
of the 1 8th century, of that disease being ever present in the 
homes of the lower classes. In the time of Sydenham, and even 
in the time of Huxham two generations after, there was no 
thought of the unwholesome domestic life graphically described 
by VVillan and others, as a cause of typhus — the overcrowding, 
the want of ventilation, the foul bedding and the exci-emental 
effluvia. 

If there had been any reason to suppose that the London of 
the Restoration, or of the time of Queen Anne, or of the first 

^ Tillison to Sancroft, 14 Sept. 1665. Cited in former volume, p. 677 : " One 
week full of s])f)ts and tokens, antl ])erliaps the siiccecdin;^ l)ill none at all." 



Typhus in London. 15 

Georges had enjoyed better public health in its crowded 
liberties and out-parishes than we know it to have done from 
the time when the authentic accounts of Lettsom and other 
dispensary physicians begin, then one might err in assuming the 
perennial existence of typhus fever and in assigning to that 
cause the bulk of the deaths under the heading of " fevers " in 
the Parish Clerks' bills. But the public health was undoubtedly 
worse in the earlier period. A writer as late as the year 18 19, 
who is calling for that reform of the dwellings of the working 
classes in London which was soon after carried out, namely the 
construction of regular streets instead of mazes of courts and 
alleys, speaks of the "silent mortality" that went on in the latter\ 
It was still more silent in earlier times, when the west end of 
London knew nothing of what was passing in the east end^ 

In all matters of public health, after the somewhat romantic 
interest in plague had ceased, the poorer parts of London were 
for long an unexplored territory. Dr John Hunter, who had 
been an army physician and was afterwards in practice in 
Mayfair, began about the year 1780 to visit the homes of the 
poor in St Giles's or other parishes near him, and was surprised 
to find in them a fever not unlike the hospital typhus of his 
military experience. I quote at this stage only a sentence or 
two^ 

" It may be observed, that though the fever in the confined habitations 
of the poor does not rise to the same degree of violence as in jails and 
hospitals, yet the destruction of the human species occasioned by it must be 
much greater, from its being so widely spread among a class of people 
whose number bears a large proportion to that of the whole inhabitants. 
There are but few of the sick, so far as I have been able to learn, that find 
their way into the great hospitals in London." I shall defer the subject of 
the dwellings of the working class in London until a later stage. 

The " constitution " in Sydenham's series which succeeded 
the febrile one of 1661-64 was "pestilential fever." It began 
in the end of 1664, lasted into the spring of 1665, and passed 
by an easy transition into the plague proper. The bills for those 
months have very large weekly totals of deaths from "fever," 
as well as a good many deaths from "spotted fever," before they 
begin to have more than an occasional death from plague. It is 

^ H. Clutterbuck, M.D., Obs. on the Epidemic Fevers prevailing in the Metropolis. 
Lond. 18 1 9, pp. 58 — 60. 

^ Horace Walpole's Letters give two instances: he himself had never set foot in 
Southwark ; a small tradesman in the City had never heard of Sir Robert Walpole. 

■* Transactions of the College of Physicians, iii. 366. 



1 6 Typhus and other Continued Fevers. 

this particular form of typhus fever that Bateman had in mind 
when he wrote, in 1 8 1 8, " We never see the pestilential fever of 
Sydenham and Huxham " ; although Willan, who preceded him 
at the Carey Street dispensary, described in 1799 a fever of so 
fatal a type that it gave rise to the rumour that the plague was 
back in London. The term "pestilential" was technically applied 
to a kind of fever a degree worse than the " malignant." 

Willis, the earliest of the Restoration authorities on fevers, 
had three names in an ascending scale of severity — putrid, malig- 
nant and pestilential. The putrid fevers were what we might 
call idiopathic, engendered within the body in some way personal 
to the individual from " putrefaction " or fermentation of the 
humours ; all the intermittents were included in that class, and 
the theory of their cure by bark was that the drug corrected 
putridity. In the malignant and pestilential, an altogether new 
element came in — the ro Oelov of Hippocrates, the mysterious 
something which we call infection ; and of these two infectious 
fevers, the malignant was milder than the pestilential. 

Morton drew out the scale of fevers in an elaborate classifi- 
cation, of which only the last section of continued contagious 
fevers concerns us at present^ : 

(Fever mostly with sweats and 
other signs of mahgnity, but 
without buboes, carbuncles, pe- 
techiae or miliary rash. 

Synochus X ( Fever with petechiae, purple 

Pestilential Fever J spots, miliaria, morbillous rash 

ion the chest. 

Plague ^ With buboes, carbuncles and 

^ \black spots. 

The order in this Table was also the order in time : the fever 
of 1 66 1, which Willis calls malignant, remained as the constitu- 

^ Willis, Op. ed. 1682, Amstelod. p. no. " De febribus pestilentibus " : "Etenim 
vulgo notum est febres interduni populariter regnare, quae pro symptomatum 
vehementia, summa aegrorum strage, et magna vi contagii, pestilentiae vix cedant ; 
quae tamen, quia putridarum typos innotantur, nee adeo certo affectos interemunt aut 
alios inficiunt baud pestis sed diminutiori 7i.T^Y>e\\a.i\OY\e febris pcsiilciis nomen merentur. 
Praeter has dantur alterlus generis febres, quarum et pernicies et contagium se 
remissius habent, quia tamen supra putridarum vires infestae sunt, et in se aliquatenus 
TO Oelov IIi|3pocratis continere videntur, tenuiori adhuc vocabulo febres malignae 
appellantur." 

The war-typhus of 1643, which was sometimes bubonic, and was succeeded by 
])lague in 1644, is given as an example oi febris pestihns ; the epidemic of 1661 as an 
example of nia/igiia. 

" Pyrc/ologia, i. 68. 



Reigning Epidemics following the Plague. 17 

tion of the years following vintil the end of 1664; then began 
the pestilential, which passed definitely in the spring of 1665 
into the plague proper. Willis, Sydenham and Morton, differing 
as they did on many points of theory and treatment, all alike 
taught the scale of malignity in fevers and plague, and all used 
the language of "constitutions." The Great Plague of 1665 was, 
in their view, the climax of a succession of febrile constitutions 
of the air, being attended by much pestilential fever and 
followed by a fever which Morton places in the milder class of 

The epidemic Constitutions following the Great Plague. 

During the ten or twelve years following the Great Plague of 
London, the epidemic maladies which Sydenham dwelt most 
upon as the reigning types will appear on close scrutiny to have 
been on the whole proper to the earlier years of life. This 
cannot be shown in the simple way of figures ; for the ages at 
death from the several maladies, although they were in the books 
of the Parish Clerks, were not published. 

There was some continued fever every year, which we may . 
take to have been chiefly the endemic typhus of a great city, and 
there were also deaths among adults due to those reigning 
epidemics which fell most on the young. In 1667 and 1668 the 
leading epidemic was smallpox, with a continued fever towards 
the end of the period which Sydenham called "variolous," for no 
other reason, apparently, than that it was part of a variolous 
constitution. In the autumn of 1669, and in the three years 
following, the epidemic mortality was peculiarly infantile, in the 
form of diarrhoea or " griping in the guts," with some dysentery 
of adults, and some measles in 1670. From 1673 to 1676, the 
constitution was a comatose fever, which chiefly affected children, 
with a sharp epidemic of measles in the first half of 1674, 
attended by a very high mortality from all causes, and a severe 
smallpox in the second half of 1674, attended by a m^uch lower 
mortality from all causes. There was also an influenza for a few 
weeks in 1675. In 1678 the "intermittent" constitution returned, 
having been absent for thirteen years, and continued through 
1779-80, until its "strength was broken." In 1681 smallpox 
was unusually mortal, the deaths being more than in any previous 
year. Most of these constitutions fall to be dealt with fully in 
C. II. , 2 



1 8 Typhus and other Continued Fevers. 

other chapters : but as we are here specially concerned with the 
succession to the plague, it is to be noted how largely the 
epidemic mortality in London fell upon the age of childhood for 
a number of years after the Great Plague of 1665. It was 
observed both by English and foreign writers that the next 
epidemic following the Black Death of 1348-49, namely, that of 
1 36 1 in England and of 1359-60 in some other parts of Europe, 
fell mostly upon children and upon the upper classes of adults. 
There is doubtless some particular application of the population 
principle in the earlier instance as in the later, but not the same 
application in both. The conditions at the beginning of the three 
hundred years' reign of plague in Britain were different from 
those at the end of it. The increased prevalence of smallpox in 
the generation before the last great outburst of plague, and the 
infantile or puerile character of the epidemic fever of 1661, as 
described by Willis, show that the incidence of infectious mor- 
tality had already begun to shift towards the age of childhood. 
It looks as if the conditions of population, intricate and obscure 
as they must be confessed to be, were somehow determining 
what the reigning infectious maladies, with their special age- 
incidence, should be. Such a gradual change is the more 
probable for the reason that infectious mortality came in due 
time to be mostly an affair of childhood. The plague, which 
was the great infection of the later medieval and earlier modern 
period, was peculiarly fatal to adult lives ; on the other hand, the 
mortality from infectious diseases in our own time falls in much 
the larger ratio upon infants and children. It looks as if this 
change, now so obvious, had begun before the end of plague 
in Britain, having become more marked in the generation 
following its extinction. The direct successor of plague, so far 
as concerns age-incidence and nosological affinity, was the pesti- 
lential or malignant typhus, which came into great prominence 
in 1685-86, in circumstances that seemed to contemporaries to 
forebode a return of the plague. But before we come to that, 
there remains a little to be said of some other fevers, especially 
of the comatose fever of 1673-76, which was largely an affair of 
childhood. 

Pcpys says that he went on 3 May, 1668, to Old Street 
(St Luke's) to see Admiral Sir Thomas Teddiman, " who is very 
ill in bed of a fever," and, in a later entry, that he "did die by a 
thrush in his mouth" on the 12th of May. Next year, 1669, 



The Ley den Feiwr of 1669. 19 

Pepys and his wife went on tour through several parts of Europe, 
and had hardly returned to their house in Seething Lane when 
the lady fell ill of a fever ; on 2nd November, it was " so severe 
as to render her recovery desperate," and on loth November she 
died, in her 29th year, — a surprising sequel, as her husband felt, 
to a "voyage so full of health and content." These two years, 
for which we have a sample of the London fevers, were marked 
in the Netherlands by epidemics of fevers which are among the 
most extraordinary in the whole history. At Leyden in 1669 
the fever reached such a height as to cut off 7000 — a mortality 
which would not have been surprising if the disease had been 
plague ; but it was not plague, it wanted the buboes, carbuncles 
&c., was longer in its course, and, strangest of all, affected the 
upper classes far more severely than the poor, so much so " that 
of seventy men administering the public affairs, scarcely two were 
left^" while, according to Fanois, who was the Leyden poor's 
doctor, the lower classes, " protected as it were by having 
survived the simpler forms of fever," suffered from this malignant 
epidemic far less than the rich\ The mortality is said to have 
risen as high as three-fourths of the attacks. At Haarlem the 
burials in a week rose to three or four hundred (which was a fair 
week's average for London itself in an ordinary season), the 
epidemic lasting four months and leaving hardly one family 
untouched. Among the symptoms were extreme praecordial 
anxiety, weight at the pit of the stomach, constant nausea and 
loathing, vomiting, in part bilious but chiefly " pituitous," thirst 
and restless tossing. It was attended by an affection of the 
throat and mouth — an angina with aphthae or thrush of the 
palate. The pools and other sources of water for domestic use 
were unusually stagnant that summer in Holland, and were 
commonly blamed for the epidemic ; but Fanois points out that 
at Haarlem and Emden, where similar fevers raged, " salubriores 
non desunt aquael" 

^ C. L. Morley, De viorbo epidemico, in 1678 — 9, narratio. Lond. 1680. 

^ Guido Fanois, De inorbo epidemico hacteims inaudito, praeterita aestate anni 1669 
Lugditni Batavoriini vicinisqiie locis grassante. Lugd. Bat. 1671. 

* Brownrigg cites the Leyden epidemic of 1669, which he calls an intermitting 
fever, as an instance of the effects of changes in the ground water ; it was " power- 
fully aggravated by the mixture of salt water with the stagnant water of the canals and 
ditches. This fever happened in the month of August, 1669, and continued to the 
end of January, 1670." "Observations on the Means of Preventing Epidemic 
Fevers." Printed in the Literary Life of W. Brozviirigg, M.D., F.R.S. By Joshua 
Dixon, Whitehaven, 1801. 

2-=-2 



20 Typhis and other Conthnied Fei'ers. 

After such an instance as the Leyden fever of 1669, nothing 
is incredible in the records of fever subsequent to the extinction 
of plague. Turning to Sydenham's account of the continued 
fever which occurred in London during the same season, the 
latter half of 1669, as well as in the three years following, we 
find that if was characterized rarely by diarrhoea or sweats, 
commonly by pain in the head, by a moist white tongue which 
afterwards became covered by a dense skin, and by a greater 
tendency than Sydenham had ever seen to aphthae (the "thrush 
in the mouth" of Admiral Teddiman in 1668) when death 
threatened — the same being a "deposition from the blood of 
foul and acrid matter upon the mouth and throat." But London 
in 1668 and 1669 suffered little from fevers in comparison to 
Leyden, Haarlem and other Dutch towns, its high mortality in 
the summer and autumn of 1669 being from infantile diarrhoea, 
cholera nostras and dysentery. 

Sydenham's continued fever from 1673 to 1676 (he was 
absent from his practice in 1677 owing to ill health) was a 
malady which affected adults as well as children, but, it would 
appear, the latter especially. The only characteristic case given 
is of a boy of nine who did not begin to mend until the thirtieth 
day. Many recovered in a fortnight, while others were not clear 
of the fever in a month. On account of the remarkable stupor 
which almost always attended it, Sydenham called the fever of 
this constitution a comatose fever. It began with sharp pains in 
the head and back, pains in the limbs, heats and chills, etc. 
His account of the comatose state is exactly like that given by 
Willis for the fever of children in 1661 — profound stupor, 
sometimes for a week long, so profound in some as to pass 
into absolute aphonia (the " acute fever with dumbness " of later 
writers), while others would talk a few words in their sleep, or 
would seem to be angry or perturbed by something (the 
chimaeras mentioned by Willis) and would then become tran- 
quil again ; when roused to take physic or to drink they would 
open the eyes for a moment and then fall back into stupor. 
When they began to mend, they would crave for absurd things 
to eat or drink. During convalescence the head, through 
weakness, could not be kept straight but would incline first to 
one side and then to the other\ 

1 Ohs. A fed. ^nl e<l., v. 2. 



The Fevers of 1680-84. 21 

The years 1678- 1680 witnessed remarkable epidemics of 
ague, such as had occurred on several occasions before, the last 
in the years 1657-59. They engross so much of Sydenham's 
writing, especially in connexion with the Peruvian-bark con- 
troversy, that we hear little of any other fever until the great 
epidemic of continued fever, or typhus, in 1685-6. But he 
does mention briefly that the interval between the decline of the 
agues in 1680 and the beginning of the "new fever" of 1685, 
was occupied by " continued depuratory " fevers — depuratory of 
the dregs of the preceding intermittent constitution, and com- 
parable in that respect to the fevers of 1661-64 which followed 
the agues of 1657-59 \ 

Sydenham's term " depuratory " does not help us much ; 
but we learn something from Morton as to what fevers were 
prevalent, besides the epidemical intermittents, in the years 
preceding the epidemic of 1685-86. Morton classes them as 
continued crwexv'i (Sj/noc/ia), by which he means something less 
malignant than Synochis. A fever which began in the milder 
form would often degenerate into the more malignant, the cause 
assigned, in the usual recriminatory manner of the time between 
rival schools, being mistaken treatment. But sometimes the 
fever was malignant from the outset, with purple spots, pete- 
chiae, morbillous efflorescence, watery vesicles on the neck and 
breast, buboes, and anthraceous boils. All these fevers, says 
Morton, whether they were spurious forms of synocha, or 
malignant from the outset, were sporadic, '' neque contagione, ut 
in pestilentiali constitutione, sese propagabant^" This points to 
their having been part of that strange aguish epidemic of which 
an account is given in another chapter. In Short's abstracts of 
parish registers, the year 1680 seems to have been the most 
unhealthy of the series in country parishes, and that is borne out 
by one Lamport, or Lampard, an empiric who practised in 
Hampshire : " I will tell you somewhat concerning a malignant 
fever. In the year '80 or '81 there were' great numbers of 
people died of such fevers, many whereby were taken with 
vomitings, etc., yet I had the good fortune to cure eighteen in 
the parish of Aldingbourn, not one dying, in that great compass, 
of that disease^." The moral is that the empiric recovered his 

^ Epist. I. Respons. §§ 56, 57. 
" Pyretologie^ i. 429. 

■^ John Lamport alias Lampard, A direct Method of ordering and curing People 0/ 
that loathsome disease the Smallpox. Loud. 1685, p. 28. 



22 TypJms and other Contimted Fevers. 

cases, whereas the regular faculty lost theirs ; which means 
that the fevers were of various degrees, some aguish, some 
typhus, as in the exactly similar circumstances a century after, 
1780-85. 

In the London Bills from 1681 to 1684, the deaths from fever 
were many, with some from " spotted fever " nearly every week, 
while the annual mortalities from all causes were high. It is 
the more remarkable, therefore, that Sydenham should have 
discovered, in the beginning of 1685, the outbreak of a new 
fever, different from any that had prevailed for seven years 
before. The explanation seems to be that a malignant typhus 
fever, such as might have been discovered in any year in the 
crowded parishes where the working classes lived, broke out at 
the Court end of the town, where Sydenham's practice lay. 



The epidemic fever of 1685-86. 

A letter of 12 March, 1685, says: "Sir R. Mason died this 
morning in his lodging at Whitehall. A fever rages that proves 
very mortal, and gives great apprehensions of a plague \" 
Sydenham also was reminded of the circumstances preceding 
the Great Plague of London in 1665. In his first account of 
the epidemic of fever in 1685 ^ which began with a thaw in 
February, he points out that the thaw in March, 1665, had been 
followed by pestilential fever and thereafter by the plague 
proper. In a later reference, when the epidemic of fever was 
in its second year (1686) he says: "How long it may last I 
shall not guess ; nor do I quite know whether it may not be a 
certain more spirituous, subtle beginning, and as if priinordiuni, 
of the former depuratory fever [1661-64] which was followed 
by the most terrible plague. There are some phenomena which 
so far incline me to that beliefs" However, no plague followed 
the malignant, if not pestilential, fever of 1685-86. The reign 
of plague, as the event showed, was over ; the fever which had 
been on former occasions its portent and satellite, came into the 
place of reigning disease. It is true that Sydenham does not 
identify the fever of 1685-86 by name as pestilential fever; on 

' Hist. MSS. Com. v. i86. Duke of Sutherland's historical papers. 
-' Schedula Moniloria I. " De novae febris ingressu." §§ 2, 3. 
•■' Ibid. § 46. 



The Seasons preceding the Typhus of 1685-86. 23 

the contrary, he entitles his essay " De Novae Febris Ingressu." 
But the novelty of type was partly in contrast to the fevers 
immediately preceding, which admitted treatment by bark, and 
its principal difference from the pestilential fever of former 
occasions seems to have been that it was not followed by 
plague\ Its antecedents and circumstances were very much 
those of plague itself Its mortality was greatest in the old 
plague-seasons of summer and autumn, it had slight relation to 
famine or scarcity, or to other obvious cause of domestic typhus. 
Sydenham can find no explanation of the new constitution but 
" some secret and recondite change in the bowels of the earth 
pervading the whole atmosphere, or some influence of the 
celestial bodies." He enlarges, however, on the character of 
the seasons preceding, which would have affected the surface, 
if not the bowels, of the earth, and the levels of the ground- 
water. 

The winter of 1683-84 was one of intense frost; an ice- 
carnival was held on the Thames during the whole of January. 
The long dry frost of winter was followed by an excessively hot 
and dry summer, the drought being such as Evelyn did not 
remember, and as "no man in England had known." For eight 
or nine months there had not been above one or two con- 
siderable showers, which came in storms. The winter of 1684-85 
set in early, and became "a long and cruel frost," more in- 
terrupted, however, than that of the year before. The spring 
was again dry, and it was not until the end of May 1685 that 
"we had plentiful rain after two years' excessive drought and 
severe winters'-'." 

The two years of excessive drought, with severe winters, had 
their effect upon the public health, as will appear from Short's 
abstracts of parish registers in town and country*; the years 
1683-85 being conspicuous for the excess of burials over 
baptisms : 

1 In the Belvoir Letters [Hist. MSS. Com. Calendar) Charles Bertie writes from 
London to the Countess of Rutland, 26 January, ifiSs, that "many are sick of 
pestilential fevers." Evelyn says that the winter of 1685-6 was extraordinarily wet 
and mild, but does not mention sickness until June, 1686, when the weather was hot 
and the camp at Hounslow Heath was broken up owing to sickness. 

2 Evelyn's Diaiy, which gives other particulars, including a description of the 
ice-carnival on the Thames. 

^ Thomas Short, M.D. of Sheffield, Neiu Observations on City, Town and 
Country Bills of Mortality. London, 1750. 



24 



Typlms and other Continued Fevers. 







Country Parishes. 






Year 


Registers 


Registers with 


Deaths in 


Births in 




examined 


excess of death 


them 


them 


1683 


140 


37 


923 


685 


1684 


140 


31 


900 


629 


1685 


140 


19 


574 


478 


1686 


140 


16 


419 


301 


1687 


143 


19 


522 


427 


1688 


143 


II 

Towns. 


327 


267 


1683 


25 


8 


1398 


1 169 


1684 


25 


8 


1243 


865 


1685 


25 


4 


1 191 


741 


1686 


25 


2 


555 


418 


1687 


25 


I 


313 


269 


1688 


25 


2 


191 


146 



There is no clue to the forms of sickness that caused the 
excessive mortality in country parishes and provincial towns. 
But in London it appears from the Bills that the one great 
cause of the unusual excess of deaths in 1684 was an enormous 
mortality from infantile diarrhoea, from the end of July to the 
middle of September, during the weather which Evelyn describes 
as excessively hot and dry with occasional storms of rain. 

It was in the second year of the long drought, February, 1685, 
that Sydenham dated the beginning of his new febrile constitu- 
tions. The mortality of 1685 was just twenty deaths more than 
in 1684 (23,222); but fever (with spotted fever) and smallpox 
had each a thousand more out of the total than in the year 
before. Sydenham says that the fever did not spare children, 
which might be alleged of typhus at all times ; but a fever of 
the kind, even if it ran through the children of a household, 
seldom cut off the very young, the mortality being in greatest 
part of adults and adolescents. Excepting smallpox for the 
year 1685, infantile and children's maladies were not prominent 
during the constitution of the " new fever ; " the usual items of 
high infantile mortality, such as convulsions and " griping in the 
guts" or infantile diarrhoea, were moderate and even low. 
Hence, although the weekly fever-deaths in the following Table 
may not appear sufficient for the professional and other interest 
that they excited, it is to be kept in mind that they had been 
mostly of adult lives. It is probable also that a good many of 
them had l)ccn among the well-to-do, and perhaps at first in the 



Mortality from Fever in Loudon, 1685. 25 

West End ; for there is nothing in the height of the weekly bills 
for all London to bear out the remark of the letter of 12 March, 
already quoted, "A fever rages that proves very mortal and 
gives apprehensions of a plague." 

Weekly Mortalities in London. 
1685. 



Week 






Of spotted 


Of small- 


Of griping 


ending 


Dead 


Of fever 


fever 


pox 


in the guts 


/[arch 3 


376 


49 





II 


35 


10 


458 


11 


2 


30 


31 


17 


367 


SZ 


I 


25 


17 


24 


441 


63 


3 


33 


27 


31 


366 


53 


5 


24 


Z^ 


April 7 


421 


47 


10 


28 


30 


14 


433 


64 


8 


32 


27 


21 


473 


66 


6 


47 


45 


28 


470 


68 


3 


49 


45 


May 5 


385 


50 


6 


35 


39 


12 


447 


75 


3 


59 


41 


19 


437 


79 


4 


58 


43 


26 


452 


61 


2 


74 


39 


June 2 


469 


65 


8 


65 


36 


9 


521 


88 


14 


62 


41 


16 


499 


91 


9 


66 


34 


23 


478 


76 


12 


71 


53 


30 


526 


82 


13 


84 


45 


July 7 


497 


81 


8 


87 


53 


14 


478 


82 


II 


78 


51 


21 


464 


79 


II 


87 


47 


28 


488 


62 


6 


68 


54 


Aug. 4 


493 


82 


5 


86 


SI 


II 


529 


109 


13 


89 


47 


18 


580 


74 


13 


99 


71 


25 


536 


91 


7 


67 


85 


Sept. I 


556 


94 


13 


53 


104 


8 


539 


82 


10 


81 


77 


15 


48s 


90 


7 


63 


70 


22 


459 


90 


10 


37 


51 


29 


502 


114 


3 


58 


53 


Oct. 6 


444 


108 


II 


40 


54 


13 


445 


89 


13 • 


61 


38 


20 


369 


86 


5 


40 


28 


27 


379 


73 


7 


29 


45 


Nov. 3 


443 


96 


8 


55 


43 


10 


410 


84 


7 


26 


35 


17 


432 


103 


8 


35 


39 


24 


471 


107 


6 


56 


31 


Dec. I 


384 


87 


4 


36 


24 


8 


452 


98 


8 


49 


24 


IS 


403 


69 


3 


29 


47 


22 


438 


99 


2 


34 


27 


29 


432 


80 


9 


28 


28 



26 



TypJms and other Continued Fevers. 





PF^^/^/j/ Mortalities 


in London. 










1686. 








Week 






Of spotted 


Of small- 


Of griping 


ending 


Dead 


Of fever 


fever 


pox 


in the guts 


Jan. 5 


394 


80 


5 


28 


29 


12 


400 


80 


3 


27 


48 ' 


19 


396 


67 


5 


36 


32 


26 


366 


76 


2 


21 


30 


Feb. 2 


452 


87 


8 


16 


30 


9 


416 


78 


5 


37 


30 


16 


405 


94 


9 


20 


25 


23 


419 


74 


7 


16 


40 


/larch 2 


417 


84 


I 


20 


yi 


9 


455 


95 


6 


18 


30 


16 


415 


71 


10 


31 


21 


23 


453 


78 


II 


22 


46 ^ 


30 


372 


58 


8 


17 


35 


April 6 


392 


80 


II 


13 


27 


13 


393 


72 


7 


21 


29 


20 


420 


61 


10 


26 


37 


27 


471 


99 


9 


27 


22 


May 4 


429 


78 


21 


28 


46 


II 


374 


71 


6 


16 


22 


18 


395 


69 


5 


17 


3 (sic) 


25 


395 


66 


II 


24 


36 


June I 


Z^Z 


63 


4 


15 


49 


8 


404 


66 


6 


26 


38 


15 


523 


88 


9 


43 


64 


22 


503 


99 


9 


25 


73 


29 


473 


90 


10 


31 


62 


July 6 


430 


71 


6 


18 


62 


13 


401 


76 


2 


19 


56 


20 


464 


87 


14 


24 


74 


27 


508 


99 


3 


23 


76 


Aug. 3 


506 


86 


9 


14 


90 


10 


493 


74 


7 


14 


1 04 


17 


522 


99 


7 


26 


lOI 


24 


536 


"5 


5 


18 


104 


31 


520 


90 


8 


22 


93 


Sept. 7 


531 


94 


4 . 


21 


104 


14 


498 


84 


6 


18 


no 


21 


540 


100 


3 


17 


lOI 


28 


443 


90 


5 


13 


67 


Oct. 5 


425 


81 


4 


13 


60 


12 


432 


96 


2 


9 


56 


19 


391 


73 


I 


9 


33 


26 


402 


79 


3 


II 


43 


Nov. 2 


373 


64 


I 


23 


39 


9 


456 


85 


I 


19 


31 


16 


401 


73 


2 


9 


23 


23 


359 


61 


4 


10 


54 


30 


397 


68 


I 


7 


34 


\y&c. 7 


359 


76 





9 


21 


14 


438 


60 





8 


46 


21 


354 


49 


I 


8 


39 


28 


356 


53 


2 


9 


32 



Type of the Fever in 1685-86. 27 

Sydenham says that he regarded the new fever at first as 
nothing more than the "bastard peripneumony " which he had 
described for previous seasons ; but he had soon cause to see 
that it wanted the violent cough, the racking pain in the head 
during coughing, the giddiness caused by the slightest movement, 
and the excessive dyspnoea of the latter (Huxham likewise 
distinguished typhus from " bastard peripneumony " ). The 
early symptoms of the " new fever " were alternating chills and 
flushings, pain in the head and limbs, a cough, which might 
go off soon, with pain in the neck and throat. The fever was 
a continued one, with exacerbation towards evening ; it was apt 
to change into a phrensy, with tranquil or muttering delirium ; 
petechiae and livid blotches were brought out in some cases 
(Sydenham thought they were caused by cordials and a heating 
regimen), and there were occasional eruptions of miliary vesicles. 
The tongue might be moist and white at the edges for a time, 
latterly brown and dry. Clammy sweats were apt to break out, 
especially from the head. If the brain became the organ most 
touched, the fever-heat declined, the pulse became irregular, and 
jerking of the limbs came on before death. 

Later writers, for example those who described the great 
epidemic fever of 1741, have identified the fever of 1685-86 with 
the contagious malignant fever afterwards called typhus, and 
Murchison, in his brief retrospect of typhus in Britain, has 
included it under that name. Sydenham mentions petechiae 
and livid blotches in some cases, and the Bills give a good many 
of the deaths in the worst weeks of the epidemic under the 
head of " spotted fever." It is not at first easy to understand 
why Sydenham should have written an essay specially upon 
it, in September, 1686, to claim it as a new fever ^ and not 
rather as the old pestilential fever — " populares meos admonens 
de subingressu novae cujusdam Constitutionis, a qua pendet 
Febris nova species, a nuper grassantibus multum abludens." 
It should be kept in mind that his motive was correct treatment, 

^ Freind {Nine Coniuientaries upon Fever, S^c, engl. by Dale, Lond. 1730, p. 4) 
has the following general criticism upon Sydenham's varying constitutions of fevers : 
" I believe also I may truly affirm that those very fevers which Sydenham explains as 
distinct species, according to the various temperature of the seasons, do not differ 
much from one another. For, if perhaps you should except the Petechiae, they differ 
rather in degree than in kind. There hardly ever appeared a fever in any season 
where the signs so constantly answered one another, that those which you found 
collected in one person should unite after the same manner in another ; however upon 
this account you would not deny their labouring under the same distemper." 



28 Typhus and otJier Continued Fevers. 

and that the fashionable treatment of the day by Peruvian bark 
was, in his judgment, unsuited to this fever, however much 
it may have suited the epidemical intermittents of 1678-79 
and the " depuratory " dregs of them for several years after. 
Physicians, he says, had learned to drive off by bark the fevers 
of the former constitution, from 1677 to the beginning of 1685, 
even when the fever intermitted little and sometimes when it 
intermitted not at all ; and they saw an indication for bark in 
the nocturnal exacerbations of the new fever. Sydenham found 
that even large doses of bark did not free the patient from fever, 
and that restoration to health under treatment with the bark 
was due " magis fortunato alicui morbi eventu quam corticis 
viribus." He seeks to establish the indications for another 
treatment by setting forth the symptoms minutely ; and as the 
question of bark in fevers was the great medical question of the 
time, this may well have been Sydenham's motive for discovering 
in the epidemic of 1685-6 a "new fever" although he does not 
say so in as many words. We have a good instance of how 
the bark-craze was at this time influencing the very highest 
circles of practice in the case of Lord Keeper Guildford, in July, 
1685, as related in another chapter. 

It will be seen, from the table of weekly deaths that the 
second of the two hard winters was over before the fever began 
to attract notice. Sydenham compares its beginning after the 
thaw in February, 1685, to the beginning of the plague when 
the frost broke in March, 1665. 

If it had been merely the typhus of a hard winter, of 
overcrowding indoors, of work and wages stopped by the frost, 
and of want of fuel (which things Evelyn mentions as matters of 
fact), it would have come sooner than the spring of 1685. The 
Bills for years before have regularly a good many deaths from 
fever, and always some from spotted fever ; but these may have 
come from parishes wholly beyond the range of Sydenham's 
practice. The fever began definitely for him in February, 1685, 
and was at its worst in the old plague-seasons of summer and 
autumn. If the seasons had any relation at all to it, the 
epidemic was a late effect of the long drought, an effect which 
was manifested most when the rain came, in the summer of 1685 
and throughout the mild winter and normal summer of 1685-86. 
It must have been for that reason that Sydenham traced the 
source of it to "some secret and recondite chancre in tlie bowels 



Telhtric Origin of Epidemic Fever. 29 

of the earth," rather than to a change in the sensible qualities of 
the air. One must ever bear in mind that the physicians of the 
Restoration gave no thought to insanitary conditions of living ; 
in that respect the later Stuart period seems to have been 
behind the Elizabethan or even the medieval ; we cannot err 
in assuming, behind all Sydenham's speculative causes, a great 
deal of unwholesomeness indoors. Sydenham's fullest reference 
to the subterranean sources of poisonous miasmata occurs in his 
tractate on Gout : 

"Whether it be that the bowels of the earth, if one may so speak, 
undergo various changes, so that by the accession of vapours exhaled there- 
from the air is disturbed, or that the whole atmosphere is infected by a 
change which some peculiar conjunction of certain of the heavenly bodies 
induces in it ; — the matter so falls out that at this or that time the air is 
furnished with particles that are adverse to the economy of the human 
body, just as at another time it is impregnated with particles of a like 
kind that agree ill with the bodies of some species of brute animals. At 
these times, as often as by inspiration we draw into the naked blood 
miasmata of this kind, noxious and inimical to nature, and we fall into those 
epidemical diseases which they are apt to produce, Nature raises a fever, — 
her accustomed means of vindicating the blood from some hostile matter. 
And such diseases are commonly called epidemical j and they are short and 
sharp because they have thus a quick and violent movement^." 

It was Sydenham's intimate friend Robert Boyle who worked 
out the hypothesis of subterraneous miasmata as a cause of epi- 
demic (and endemic) diseases. An account of his theory will be 
found in the chapter on Influenzas and Epidemic Agues. It may 
be said here that it needs only a few changes, especially the 
substitution of organic for inorganic matters in the soil, to bring 
it into line with the modern doctrine of miasmatic infective 
disease as expounded by the Munich school. 

It has not been usual to think of spotted fever, (or of 
influenzas), in that connexion ; but a telluric source of the 
epidemic constitution of 1685-86 was clearly Sydenham's view ; 
and as the fever came in circumstances like those of the last 
great plague, and was thought at the time to be the forerunner of 
another great plague, its connexion with recondite decompositions 
in the soil, dependent on the phenomenal drought of two whole 
years before, cannot be set aside as a possibility, the less so that 
the fever, although of the type of typhus, was not a fever of 
cold, hunger, and domestic distress, but mainly of the warm, or 
mild, or soft weather following the long drought, and of many 
well-to-do-people, as in the great Netherlands fever of 1669. 

^ Tractatus de Podagra, § 35. Greenhill's edition, p. 428. 



30 Typhus and other Continued Fevers. 

My view of it is that it was the modified successor of plague, the 
pestis viitior, which used to precede and accompany the plague, 
now become the dominant constitution. The authentic figures 
of its mortality come from London ; but Sydenham says that 
its " effects were felt far more in other places " ; although Short's 
abstracts of parish registers, given above, do not indicate excessive 
mortality throughout England. 



Retrospect of the great Fever of 1623-25. 

The most instructive instance of pestis mitior in Britain is 
not the pestilential fever which led up to the last plague 
(1665-6), but the great epidemic of fever all over England and 
Scotland which reigned for two or three years before the great 
outburst of plague in 1625. I go back to this because it was 
not wholly or even mainly a famine fever (although it was as 
general as one of the medieval famine-fevers), and because in 
that respect it furnishes a close parallel to the fever of 1685-86, 
which I regard as the successor of the plague. After this 
interlude in the history, we shall proceed to consider the question 
of the final extinction of plague. 

In Scotland the fever of 1622-23 was directly connected with famine, 
but in England it was not obviously so according to the records that remain. 
The dearth in Scotland began as early as the autumn of 1621 : "Great 
skarsitie of cornes throw all the kingdome," the harvest having been spoiled 
by wet weather and unheard-of river floods ; however, abundance of foreign 
victual came in, and the scarcity was got over^. In England the same 
harvest of oats was abundant, and probably yielded the " foreign victual " 
which relieved the Scots ; but the price of wheat rose greatly 2. It was the 
year following, 1622, that really brought famine and famine-sickness to 
Scotland, as the second of two bad harvests had always done. On 21 July, 
1622, a fast was proclaimed at Aberdeen for "the present plague of dearth 
and famine, and the continuance thereof threatened by tempests, inunda- 
tions and weets likely to rot the fruit on the ground^." 

In an entry of the Chronicle of Perth, subsequent to July, 1622, it is said: 
"In this yeir about the harvest and efter, thair wes suche ane universall 
seikness in all the countrie as the ellyke hes not bene hard of. But 
speciallie in this burgh, that no familie in all the citie was frie of this 
visitation. Thair was also great mortalitie amonge the poore." From 
which it appears that the autumnal fever of 1622 was among all classes in 
Scotland. The famine in Scotland became more acute in the spring and 
summer of 1623 ; the country swarmed with beggars, and in July, says 
Calderwood, the famine increased daily until "many, both in burgh and 
land, died of hunger." At Perth ten or twelve died every day from Mid- 

^ Chronicle of Perth (Mailland Club) under date 14 Oct. 162 1. 

^ Tliorold Rojjens, Hist, of Agric. and Prices, sub anno. 

'^ Extracts from Kirli Session Records. Spalding Club, 1846. 



Universal Spotted Fever in 1623-25. 31 

summer to Michaelmas ; the disease was not the plague, but a feveri. At 
Dumfries 492 died during the first ten months of 1623, perhaps a ninth part 
of the inhabitants, about one hundred of the deaths being specially marked 
as of "poor^." The "malignant spotted fever" which caused numerous 
deaths in 1623 in Wigton, Penrith and Kendal is clearly part of the famine- 
fever of Scotland extending to the Borders and crossing them. This is 
a famine-fever of the old medieval type, like that of 1196 which, according 
to William of Newburgh " crept about everywhere," always the same acute 
fever, putting an end to the miseries of the starving, but attacking also those 
who had food. 

The same spotted fever was all over England in 1623, but it did not, as 
in Scotland, come in the wake of famine. It is true that the English harvest 
of 1622 was a good deal spoiled ; a letter of 25 September says^ : "Though 
the latter part of this summer proved so far seasonable, yet the harvest 
is scant, and corn at a great price by reason of the mildews and blasting 
generally over the whole realm," rye being quoted a few weeks later at 
7/- the bushel and wheat at 10/-, although the average of wheat for the year, 
in Rogers's tables, is not more than ^ijid. per quarter, while the average of 
next year falls to 37/8d. These were not famine-prices in England, and 
there is no evidence of general sickness directly after the harvest of 1622, 
when corn was dearest. Also, although the autumn of 1623 was a time of 
"continual wet" in England*, the price of wheat remained moderate, and 
even low as compared with the rather stiff price of the winter of 1622-23. 
But it was not until the summer and autumn of 1623 that the spotted fever 
became epidemic in England. Short's abstracts of the registers of market 
towns show how sickly that year was : 



Year. 


No. of registers 


No. with excess 


Buried in the 


Baptised in the 




examined. 


of burials. 


same. 


same. 


1622 


25 


4 


' 442 


345 , , 


1623 


25 


16 


2254 


439 (sic) 


1624 


25 


9 


978 


714 


1625 


25 


9 


666 


563 



In September, 1623, the corporation of Stamford made a collection "in this 
dangerous time of visitation," and sent £10 of it to Grantham, the rest to go 
" to London or some other town, as occasion offered." A London letter of 
6 December, 1623, from Chamberlain to Carleton says*: — 

" Here is a contagious spotted or purple fever that reigns much, which, 
together with the smallpox, hath taken away many of good sort, as well as 
meaner people." He then gives the names of notables dead of it, and adds : 
" Yet many escape, as the dean of St Paul's [Dr Donne, who used the 
occasion to compile a manual of devotion] is like to do, though he were in 
great danger." One of the Coke family writes early in January, 1624, from 
London": "Having two sons at Cambridge, we sent for them to keep 
Christmas with us, and not many days after their coming my eldest son 
Joseph fell suddenly into the sickness of the time which they call the spotted 
fever, and which after two days' extremity took away his life." From 
another letter it appears that one of his symptoms was " not being able to 
sleep," the unmistakable vigil of typhus. Although there is no word of the 
epidemic continuing in Scotland in 1624, it was undoubtedly as prevalent in 
England in that year as the year before, and prevalent in country houses as 

^ Chronicle of Perth. 

2 History of the Burgh of Duinfries. By W. MacDowall. 2nd ed. Edin. 1873, 
p. 381. 

* Court and Times of James I., ii. 331. 

* Ibid., under date 25 Oct. 1423. 

5 Ibid. ii. 439. ■ 8 Q„i Coke MSS. (Hist. MSS. Com.) i. 158. 



32 Typhus and other Continued Fevers. 

well as in towns and cities. Thus, on 7 August, 1624, Chamberlain writes : 
" The [king's] progress is now so far off that we hear little thence, but only 
that there be many sick of the spotted ague, which took away the Duke of 
Lennox in a few days. He died at Kirby," a country house in Northampton- 
shire^ On 21 August he writes again: "This spotted fever is cousin- 
german to it [the plague] at least, and makes as quick riddance almost. 
The Lady Hatton hath two or three of her children sick of it at her brother 
Fanshaw's in Essex, and hath lost her younger daughter, that was buried at 
Westminster on Wednesday night by her father ; a pretty gentlewoman, 
much lamented." A letter of 4 September says there was excessive mortality 
in London, in great part among children (doubtless from the usual infantile 
trouble of a hot autumn, diarrhoea), while " most of the rest are carried 
away by this spotted fever, which reigns almost everywhere, in the country 
as ill as here." Sir Theodore Mayerne, the king's physician, confirms this, 
under date 20 August, 1624 : the purple fever, he says, was "not so much 
contagious as common through a universal disposing cause," seizing upon 
many in the same house, and destroying numbers, being most full of 
malignity^. It was clearly an inexplicable visitation. The summer was hot 
and dry, from which character of the season, says Chamberlain, " some 
have found out a far-fetched speculation, which yet runs current, and would 
ascribe it [the spotted fever] to the extraordinary quantity of cucumbers this 
year, which the gardeners, to hasten and bring forward, used to water out of 
the next ditches, which this dry time growing low, noisome and stinking, 
poisoned the fruit. But," adds Chamberlain, " that reason will reach no 
farther than this [London] town, whereas the mortality is spread far and 
near, and takes hold of whole households in many places." He then gives 
the names of several eminent persons dead of it, and speaks of others who 
were "still in the balance^." On 9 October, "the town continues sickly 
still," and Parliament had been put off, "in consideration of the danger," 
from 2 November, 1624, to 15 February, 1625. On Ash Wednesday, 1625, 
the Marquis of Hamilton died of the pestilent fever at Moor Park, 
Rickmansworth. Thus far there had been no plague ; and if the spotted 
fever were cousin-german to the plague, as Chamberlain said, it was remark- 
able in this that it prevailed in the mansions of the rich in town and 
country and took off more victims among the upper classes than the 
plague itself even in its most terrific outbursts. However, a plague of the 
first rank followed in London and elsewhere in the summer and autumn 
of 1625. 

The cucumber-theory, above mentioned, shows how puzzled people must 
have been to account for the spotted fever, or " spotted ague " as it was also 
called, in 1624. Sir Theodore Mayerne did not think contagion from person 
to person could explain it, but referred it to " some universal disposing 
cause." It is conceivable that the famine-fever of 1622 and 1623 in Scotland 
and the Marches may have spread by contagion into England in the latter 
year ; but in 1624 there is nothing said of fever in Scotland or of scarcity as 
a primary cause in England. 

Besides the famine-fever of Scotland in 1622-23, there was another 
associated thing which should not be left out of account. Before the famine 
and fever had begun in that country, the notorious Hungarian fever was 
raging in the Palatinate, and continued to rage for four years. " Hungarian 
fever" had become the dreaded name for war-typhus of a peculiar malignity 
and diffusive power. It had been so often engendered since the i6th 
century in campaigns upon Hungarian soil as to have become known 
everywhere under the name of that country. Its infection spread, also, 
everywhere through Europe ; thus it is said to have even reached England 

' C. and T. James /., ii. 469. 

"^ Mayerne, Opera Medica, Lend. 1700. ■* Ihid. ii. 473. 



Causes of universal Typhus, 1623-24. 33 

in 1566, and again in 1589, although it is not easy to find English evidence 
of it for either year. It was this type of fever which broke out in the Upper 
Palatinate, occupied by troops of the Catholic powers, in 1620, and con- 
tinued through the years 1621, 1622 and 1623 ; as the title of one of the 
essays upon this outbreak somewhat fantastically declares, it spread "ex 
castris ad rastra, ex rastris ad rostra, ab his ad aras et focos^." Was the 
epidemic constitution of "spotted ague" in England in 1623 and 1624 
derived from the centre of famine-fever in Scotland, or from the centre of 
camp-fever in the Palatinate? In the last years of James I. communi- 
cations were frequent with the latter country, and there was of course much 
intercourse with Scotland. 

The spotted fever or spotted ague of 1623-24, the plague of 
1625, and the country agues of the same autumn make really 
a more instructive series of epidemic constitutions than any that 
fell under Sydenham's observation, so instructive, indeed, that it 
has seemed worth while to revert to it for the sake of illustrating 
the doctrine of epidemics then in vogue. That doctrine made 
little of contagion from person to person ; yet the idea of 
contagion was familiar, and had been so since medieval times. 
If we might assume contagion to explain such cases as those 
that occurred in the houses of squires and nobles, we might find 
a source of it either in the famine-fever of Scotland or in the 
war-fever of the Palatinate. But the teaching of the time was 
that it was in the air ; and if the infective principle had been 
generated either in Scotland or on the upper Rhine it had 
diffused itself in some inscrutable way. The doctrine of epidemic 
constitutions seems strange to us ; but some of the facts that 
it was meant to embrace are also strange to us. Were it not 
for an occasional reminder from influenza, we should hardly 
believe that any fevers could have travelled as the Hungarian 
fevers, the spotted fevers or " spotted agues " of former times are 
said to have done. 

On the other hand, we have now a scientific doctrine of the 
effects of great fluctuations of the ground-water upon the 
production of telluric miasmata, which may be used to rationalize 
the theory of emanations adopted by Sydenham and Boyle. 
From this modern point of view the remarkable droughts 
preceding the pestilential fevers and plagues of 1624-25 and 
1665, and preceding the fever of 1685-86, which is the one 
that immediately concerns us, may be not without significance. 

The London fever of 1685-86 having been suspected at the 
time to be the forerunner of a plague, as other such fevers in 

^ Janus Chunradus Rhumelius, Historia morhi, qui etc. Norimb. 1625. 
C. IT. 3 



34 Typhus and other Continned Fevers. 

the earlier part of the century had been, and no plague having 
ensued, the question arises most naturally at this stage, why the 
plague should have never come back in London or elsewhere in 
Britain after the great outbreak of 1665-66. 



The extinction of Plague in Britain. 

Plague had been the grand infective disease of Britain from 
the year of the Black Death, 1348-9, for more than three 
centuries, down to. 1666. The last of plague in Scotland was 
in 1647-8, in the west and north-west of England about 1650 
(in Wales probably in 1636-8), in Ireland in 1650, and in all 
other parts of the kingdom including London in 1666, the 
absolute last of its provincial prevalence having been at Peter- 
borough in the first months of 1667^ while two or three occasional 
deaths continued to occur annually in London down to 1679. 
False reports of plague, contradicted by public advertisement, 
were circulated for Bath in 1675^ and for Newcastle in 1710^; 
while in London as late as 1799, during a bad time of typhus 
fever, the occurrence of plague was alleged'*. 

It is not easy to say why the plague should have died out. 
It had been continuous in England from 1 348, at first in general 
epidemics, all over the country in certain years, thereafter mostly 
in the towns, either in great explosions at long intervals or at a 
moderate level for years together. The final outburst in 1665, 
which was one of the most severe in its whole history, had 
followed an unusually long period of freedom from plague in 
London, and was followed, as it were, by a still longer period 
of freedom until at last it could be said that the plague was 
extinct. In some large towns it had been extinct, as the event 
showed, at a much earlier date ; thus at York the last known 
epidemic was in 1604, and it can hardly be doubted that many 

^ W. D. Cooper, Archceologia, xxxvii. (1857) p. i. I had overlooked this 
important paper on English plagues in my former volume. The chief additional facts 
that it contains are the very severe plague at Cambridge in the summer of 1666, 
the deaths of 417 by plague at Peterborough in 1666, and of 8 more in the first 
quarter of 1667, and the slightness of the Nottingham outbreak, which was in 
August, 1666 (p. 12). 

^ London Gazette, i'j-21 June, 1675, repeated in the number for 28 June-i July. 

^ Brand, //ist. of Newcastle, il. 509. Report contradicted on 18 Dec. 

* "The habitations of the poor within or adjoining to the City," says Willan, 
" liave suffered greatly; and some, I am informed, have been almost depopulated, the 
infection having extended to every inmate. The rumour of a plague was totally devoid 
of foundation." 



Causes of the Extinction of Plague. 35 

other towns in England, Scotland and Ireland would have closed 
their records of plague earlier than they did had not the sieges 
and military occupations of the Civil Wars given especial occasion 
for the seeds of the infection to spring into life. Plague seemed 
to be dying out all over England and Scotland (in Ireland it is 
little heard of except in connexion with the Elizabethan and 
Cromwellian conquests) for some time before its final grand 
explosion in London in 1665. 

In seeking for the causes of its decline and extinction we 
must keep prominently in view the fact that the virus was 
brought into the country from abroad as the Black Death of 
1348-9. But for that importation it is conceivable that there 
would have been no signal history of plague in Britain. Its original 
prevalence was on a great scale, and there were several • other 
widespread epidemics throughout the rest of the 14th century. 
In the first volume of this history I have collected evidence 
that plague was endemic or steady for long periods of the 15th 
and 1 6th centuries in London, with greater outbursts at intervals, 
and that in the 17th century it came chiefly in great explosions. 
Something must have served to keep the virus in the country, 
and more especially in the towns, until at length it was 
exhausted. An exotic infection, or one that had not arisen from 
indigenous conditions, and would probably never have so arisen, 
does not remain indefinitely in the country to which it is 
imported. Thus Asiatic cholera, imported into Europe on six, 
or perhaps five, occasions in the 19th century, has never become 
domesticated ; and yellow fever had a career in the southern 
provinces of Spain during some twenty years only. Plague 
did become domesticated for about three centuries in England, 
and for longer in some other countries of Europe ; but it died 
out at length, and it would almost certainly have died out sooner 
had it not found in all European countries some conditions not 
altogether unsuited to it. What were the favouring conditions .? 

If, as I believe, the virus of plague had its habitat in the soil, 
from which it rose in emanations, and if it depended therein, 
both remotely for its origin in some distant country, as well as 
immediately for its continuance in all countries, upon the de- 
composition of human bodies, then it is easy to understand that 
the immense mortalities caused by each epidemic would preserve 
the seeds of the disease, or the crude matters of the disease, in 
the soil. Buried plague-bodies would be the most obvious 

3—2 



36 Typhus and other Continued Fevers. 

sources of future plagues. But if the theory given of the Black 
Death be correct, bodies dead of famine or farnine-fever would 
also favour in an especial way the continuance of the plague- 
virus in certain spots of ground, although they would probably 
never have originated it in this country. Moreover, the products 
of ordinary cadaveric decomposition would be so much pabulum 
or nutriment for the continuance of the virus. But all those 
things being constant, the continuance of plague would largely 
depend upon the manner in which the dead, after plague, or 
after famine and fever, or in general, were disposed of. The 
soil of all England in 1348-9 was filled with multitudes of the 
dead laid in trenches, and there were several general revivals of 
plague in the fifty or sixty years following. In London there 
were plague-pits opened in the suburbs in many great epidemics 
during three centuries. Even when there was no epidemic the 
dead were laid in the ground in such a manner that their resolution 
was speedy, and the diffusion of the products unchecked. But 
it is undoubted that greater care in the disposal of the dead did 
at length come into vogue. Thus, in the Black Book of the 
Corporation of Tewkesbury there is an entry under the year 
1603, that all those dead of plague, "to avoid the perill, were 
buried in coffins of bourde," the disease having carried off no 
fewer than 560 the year before (1602) and being then in its 
second season \ The reason given is "to avoid the peril," and 
it is beyond question that burial in a coffin did in fact delay 
decomposition (unless in peculiar circumstances which need not 
be particularized), and kept the cadaveric products from passing 
quickly and freely into the pores of the ground. Again, if the 
burial were in such coffins as the Chinese commonly use, the 
decomposition would proceed almost as slowly as if the body 
had been embalmed, and with as little risk of befouling the soil. 
For a long time in England such burials were the privilege only 
of the rich ; but as wealth increased by commerce they became 
the privilege of all classes; and in the last great plague of London, 
as I said in my former volume, " even at the worst time coffins 
would seem to have been got for most." Defoe's account of the 
burials in heaps in plague-pits is so exactly like that of Dekker 
for the plague of 1603, and of other contemporaries for the 
plague of 1625, that one may reasonably suspect him to 
have used these earlier accounts as his authority for the practice 
' Rudder, A Nav History of Gloucestershire, 1779, P* 7.^7' 



Burial in coffins a cause of Extinction of Plague. 37 

in 1665, which he had no direct knowledge of. However, I do 
not contend that there were no such burials in 1665 ; just as one 
learns from Dekker that the coffin -makers in 1603 were busily- 
employed and grew rich, although he also describes how a 
husband " saw his wife and his deadly enemy whom he hated " 
launched into the pit " within a pair of sheets." In ordinary 
times, as we learn from the tables of burial-dues, there were 
poorer interments without coffins as late as 1628, according to a 
document printed by Spelman, the name of the parish being 
withheld, and even as late as 1672 in the parish of St Giles's, 
Cripplegate, Spelman's object in writing in 1641 was to protest 
against the mercenary practices of the clergy in the matter of 
burial, recalling the numerous canons of the medieval Church 
directed against all such forms of simony ; and incidentally he 
mentions that it was testified before the Commissioners that a 
certain parson "had made forty pound of one grave in ten yeeres, 
by ten pounds at a time"^ — a "tenancy of the soil " short enough 
to satisfy even the so-called Church of England Burial Reform 
Association. The use of coffins in the burial of the very poorest 
is now so universal that we hardly realize how gradually it was 
introduced. I am unable to say when burial in a sheet or 
cerecloth ceased ; but it became less and less the rule for the 
poorer classes throughout the 17th century. In 1666 was passed 
the Act for burial in woollen, which was re-enacted more strictly 
in 1678^ The motive of it was to encourage the native woollen 
manufactures, or to prevent the money of the country from 
being expended on foreign-made linen ; and its clauses ordained 
that woollen should be substituted for linen in the lining of the 
coffin and in the shrouding of the corpse, but that no penalty 
should be exacted for burying in linen any that shall die of the 
plague. Whether it prohibited in effect the use of linen cere- 
cloths to enshroud corpses where no coffin was used does not 
appear clearly from the terms of the Act ; but, as the intention 
was to discourage the use of linen, and to bring in the use of 
woollen, for all purposes of burial, it is probable that it served 
to put an end to coffinless burials altogether, wherever it was 



1 Spelman, De Sepultura. English ed. 1641, p. 28. He cites the burial fees paid 
to the parson as twice as much for coffined as for uncoffined corpses. This agrees on 
the whole with the evidence adduced in the former volume of this history, p. 335. 

- 18 and 19 Car. II. cap. 4 ; 30 Car. II. (i), cap. 3. These Acts were repealed by 
54 Geo. III., cap. 108. 



38 TypJms and other Continued Fevers. 

enforced, inasmuch as the prescribed material was wholly un- 
suited for the purpose of a cerecloth. 

The history of the London plague-pit between Soho and the 
present Regent Street shows that, after the last great plague 
of 1665-66, more caution was used against infection from the 
buried plague-bodies. Macaulay says it was popularly believed 
that the earth was deeply tainted with infection, and could not 
be disturbed without imminent risk to human life ; and he 
asserts that no foundations were laid in the pest-field till two 
generations had passed and till the spot had long been sur- 
rounded with buildings, the space being left blank in maps of 
London as late as the end of George L's reign\ 

After 1666 the old churchyards were not less crowded than 
before, but more crowded, perhaps because coffined corpses 
occupied more space and decayed more slowly. On 17 October, 
1672, Evelyn paid a visit to Norwich : " I observed that most of 
the churchyards (tho' some of them large enough) were filled up 
with earth, or rather the congestion of dead bodys one upon 
another, for want of earth, even to the very top of the walls, and 
some above the walls, so as the churches seemed to be built 
in pitts." The same day he had visited Sir Thomas Browne, 
the author of the famous essay on urn burial or cremation, 
(suggested to him by the digging up of forty or fifty funeral urns 
in a field at Old Walsingham). The essay is full of curious 
learning and equally curious moralizing. But Sir Thomas, 
though a physician, has not a word to say on so proximate 
a topic as the state of the Norwich churchyards, which came 
under his eyes and perhaps under his nose every day of his life^. 

The practice of burying in coffins, which came at length 
within the means of all classes, may seem too paltry a cause 
to assign, even in part, for so remarkable an effect as the absolute 
disappearance of plague after a duration of more than three 

^ History of England, i. 359. 

^ He has one or two relevant remarks : "But while we suppose common worms 
in graves, 'tis not easy to find any there ; few in churchyards above a foot deep, 
fewer or none in churches, though in fresh-decayed bodies. Teeth, bones, and hair 
give the most lasting defiance to corruption. In an hydropsical body, ten years 
buried in the churchyard, we met with a fat concretion [adipocere] where the nitre of 
the earth and the salt and lixivious liquor of the body had coagulated large lumps of 
fat into the consistence of the liardest Castille soap, whereof part remaineth with us. 
The body of the Marquis of Dorset seemed sound and handsomely cereclothed, that 
after seventy-eight years was found uncorrupted. Common tombs preserve not 
beyond powder : a firmer consistence and compage of parts might be expected from 
arefaclion, (leuj) Inuial, ur charcoal." 



Increased well-being a cause of Extinction of Plagtce. 39 

centuries. My view of the matter is that the virus would have 
died out of itself had it not been continually augmented, or fed 
by its appropriate pabulum, and that the gradual change in the 
mode of interment helped to check such augmentation or feeding. 

But the more elaborate interment of the dead was itself 
an index of the greater spending power of the community, and 
it may be said that it was the better condition of the people, and 
not this one particular thing in it, which put an end to the 
periodical recurrences of plague. In all but its earliest outbursts 
in the fourteenth, and perhaps the fifteenth century, plague had 
been peculiarly an infection of the poor, being known as " the 
poor's plague." Perhaps the chief reason why the richer classes 
usually escaped it was that they fled from the plague-tainted 
place, leaving the poorer classes unable to stir from their homes, 
exposed to the infectious air, and all the more exposed that 
their habitual employments and wages would cease, their 
sustenance become precarious, their condition lowered, and their, 
manners reckless. Again, it was not unusual for the plague to 
break out in a season of famine or scarcity, during which the 
ordinary risks of the labouring class would be aggravated. 
Famines ceased (except in Ireland, where there had been com- 
paratively little plague), and scarcities became less common. The 
sieges and occupations of the Civil Wars in the middle of the 
17th century, which undoubtedly were the occasion of the last 
outbursts of plague in many of the towns, were a brief 
experience, followed by unbroken tranquillity. Whatever things 
were tending to the removal of plague in all its old seats had 
free course thereafter. 

On the other hand, one may make too much of the increase 
of well-being among the labouring class which coincided with 
the cessation of plague. As a check upon population plague 
worked in a very remarkable way. In London, as well as in 
towns like Newcastle and Chester, plague towards the end of its 
reign arose perhaps once in a generation and made a clean 
sweep of a fifth or a fourth part of the inhabitants, including 
hardly any of the well-to-do. It destroyed, of course, many 
bread-winners and many that were not absolutely sunk in 
poverty; but its broad effect was to cut off the margin of 
poverty as if by a periodical process of pruning. The Lord 
Mayor of London wrote to the Privy Council at the end of the 
great plague of 1625: "The great mortality, although it had 



40 Typhus and other Continued Fevers. 

taken many poor people away, yet had made more poverty by 
decay of tradesmen " — a decay of trade which they might 
reasonably expect to recover from before long. No such 
ruthless shears was ever applied at intervals to the growing fringe 
of poverty in after times. The poor were a more permanent 
residue, pressing more upon each other; but they did not press 
more upon the rich, except through the poor rate ; on the 
contrary, the separation of classes became more marked. 

Perhaps I ought to give an illustration of this, so as not to 
leave so radical a change in the vague and disputable form of a 
generality. I shall take the instance of Chester ; its circuit of 
walls, remaining from the Roman conquest, is something fixed 
for the imagination to rest upon amidst changes within and 
without them. 

Passing over its medieval and its not infrequent Tudor experiences 
of epidemic sickness, let us come to the beginning of the 17th century. In 
two or three successive seasons from 1602 to 1605 it lost 1,313 persons by 
plague, as well as about 250 from other causes. The population was then 
mostly within the walls, and probably did not exceed 5000. There was 
a shipping quarter on the west side, with egress by the Water-gate to 
the landing-places on the Dee ; a millers' quarter, with corn-market and 
hostelries, on the south, connecting by the South gate and bridge with a 
hamlet across the river along the road to Wales ; a Liberty or Freedom of 
the city outside the walls on the east, along the road to Warrington and 
Manchester, with a Bar, a short distance out, as in London, to mark the 
limit of the mayor's jurisdiction ; and on the north side, within the walls, the 
cattle-market and shambles, with the market for country produce, and a 
few straggling houses without the gate on the road leading to Liverpool. 
Chester was a characteristic county town, with its cathedral clergy, its 
garrison, its resident nobility and gentry, its professional classes, its trades- 
men, market people and populace, with the addition of a shipping trade to 
Ireland and afterwards to foreign and colonial ports. Plague continuing 
from 1602 to 1605 cut off a fourth or a fifth of its population, and these the 
poorest. The gaps in the population would gradually have filled up, and the 
fringe of poverty grown again ^. 

The plague came again in 1647, and cut off 2053 in the short space 
of twenty-three weeks from 22 June to 30 November. The bills of it are 
extant", and show on what parishes the plague fell most. All the parishes 
were originally within the walls but one, St John's, the ancient collegiate 
church of Mercia, built upon a rocky knoll in the south-east angle made by 
the walls with the river. The other nine parish churches and their grave- 
yards were within the walls ; but the parishes of three of them extended 
beyond the gates. Just as the three parishes dedicated to St Botolph at the 
gates of London did. These three were St Oswald's, which included the 
Liberty on the east side, Trinity, which included the shipping quarter on the 

1 One may allege poverty on general grounds, as well as on particular. Thus, in 
1636, the mayor was unpopular : " lie was a stout man and had not the love of the 
commons. lie was cruel, and not pitying the poor, he caused many dunghills to be 
carried away; but the cost was on the poor — it being so hard times might well have 
been s]iared." Ormerod, I. ■203. 

- i'rinted plague-bill, with MS. additions, Ilarl. MS. 1929. 



The populace of Chester in plague-times and after. 41 

west as well as the houses along the Liverpool road on the north, and 
St Mary's, which included the millers' suburb across the Dee on the south. 
Hollar's map, made a few years after the plague of 1647, shows very few 
houses beyond the walls, except in the ancient Liberty on the east. But it 
will appear from the following table that the parishes which had extended 
beyond the walls must either have been very crowded close up to the walls 
(as the Gate parishes were always apt to be), or there must have actually 
been a greater population outside the gates than the contemporary map 
shows : 

Burials from Plague in the several Parishes of Chester in 23 weeks., 
Jicne 22 — Nov. 30, 1647. 

5 parishes wholly within the walls. 

Total. First Worst (7th) 

week. week. 

St Peter 75 o 14 

St Bridget 85 7 9 

St Martin 173 9 23 

St Michael 133 26 9 

St Olave 59 3 5 

3 parishes extending beyond the walls. 

St Oswald 396 II y] 

St Mary 314 5 20 

Trinity 232 I 32 

I parish wholly withotit the walls. 

St John 358 2 26 

Pesthouse 228 _o 34 

2053 64 209 

This was the last plague of Chester, but for a small outbreak in 1654. 
The next vital statistics that we get for the city are more than a century 
after, in 1774^ The population of 14,713 was then divided into two almost 
distinct parts, separated by the wall. The old city was being rebuilt, all 
but some ancient blocks of buildings held in the dead hand of the cathedral 
chapter; it was becoming a model i8th century place of residence for a 
wealthy and refined class, who were remarkably healthy and not very 
prolific, the parishes wholly within the walls having 3502 inhabitants. The 
poorer class had gone to live mostly outside the walls in new and mean 
suburbs, the three parishes at the Gates and extending now far beyond the 
walls, together with the original extramural parish of St John's, having a 
population of 11,211. There was no town in Britain where the separation of 
the rich from the poor was more complete ; there was hardly another town 
of the size where the health of the rich was better ; and although the health 
of the populace was not so bad as in the manufacturing towns of Lancashire 
and Cumberland, close at hand, yet it is hardly possible to find so great a 
contrast as that between the clean and wholesome residential quarter 
within the walls and the mean fever-stricken suburbs as described by Hay- 
garth in 1774 : 

" The inhabitants of the suburbs," he says, " are generally of the lowest 
rank ; they want most of the conveniences and comforts of fife ; their houses 
are small, close, crowded and dirty ; their diet affords very bad nourishment, 
and their cloaths are seldom changed or washed... These miserable wretches, 
even when they go abroad, carry a poisonous atmosphere round their 
bodies that is distinguished by a noisome and offensive smell, which is 
peculiarly disgustful even to the healthy and vigorous, exciting sickness and 
a sense of general debility. It cannot therefore be wondered that diseases 
should be produced where such poison is inspired with every breath." 

^ Haygarth, Phil. Trans., LXVIII. 139. 



42 TypIuLS and other Coti tinned Fevers. 

The case of Chester shows by broader contrasts than 
anywhere else the change from the public health of plague-times 
to that of more modern times. But it can hardly be said to 
show the populace better off than before ; it shows them changed 
into a proletariat, and separated from the richer classes by walls 
several feet thick. Such, at least, was the result after four 
generations of immunity from plague, a result which indicates, 
as I have said, that we may easily make too much of the 
improved well-being of the poorer classes as a cause of the 
cessation of plague. 

An easy explanation of plague ceasing in London has 
long been current, and just because it is an easy explanation 
it will probably hold the field for many years to come. It is 
that the fire of 1666 burnt out the seeds of plague. Defoe, 
writing in 1723, ascribed this opinion to certain "quacking 
philosophers," but he would hardly have said so if he could have 
foreseen the respectable authority for it in after times. The 
plague had ceased in most of its provincial centres after the 
Civil Wars, and in some of them, such as York, from as early a 
date as 1604. It ceased in all the principal cities of Western 
Europe within a few years of its cessation in London. In 
London itself it ceased after 1666, not only in the City which 
was the part burned down in September of that year, but 
in St Giles's, where the Great Plague began, in Cripplegate, 
Whitechapel and Stepney, where it was always worst, in 
Southwark, Bermondsey and Newington, in Lambeth and 
Westminster. Nor can it be said that the City was the source 
from which the infection used to spread to the Liberties and 
out-parishes. All the later plagues of London, perhaps even 
that of 1563, began in the Liberties or out-parishes and at 
length invaded the City. The part of London that was rebuilt 
after 1666 contained many finer dwelling-houses than before, 
built of stone, with substantial carpentry, and elegantly finished 
in fine and rare woods. The fronts of the new houses did not 
overhang so as to obstruct the ventilation of the streets and 
lanes; but the streets, lanes, alleys and courts were somewhat 
closely reproduced on the old foundations. A side walk in 
some streets was secured for foot-passengers by means of 
massive posts, which, with the projecting signs of houses and 
shops, were at length removed in 1766. The improvements in 
the City after the fire were mostly in the houses of the richer 



Cessation of Plague not dtie to the Fire of Loiidon. 43 

citizens. The City was the place of residence of the rich, with 
perhaps as many poorer purHeus in close proximity as the 
residential districts of London now have. But four-fifths of 
London at the time of the fire were beyond the walls of the 
City. It is in these extramural regions that the interest mostly 
lies for epidemical diseases. They remain, says Defoe in 1723, 
" still in the same condition they were in before." Unfortunately 
we know little of their condition, whether in the 17th centnry 
or in the i8th. But there must have been something in it most 
unfavourable to health ; for we find from the Bills of Mortality 
that the cessation of plague made hardly any diff'erence to the 
annual average of deaths, the increase of population being 
allowed for. This fact makes the disappearance of plague all 
the more remarkable. 



Fevers to the end of the 17th century. 

The epidemical seasons of 1685-86 were the last that 
Sydenham recorded ; he was shortly after laid aside from active 
work by gout, and died in 1689. Morton, who made notes of 
fevers and smallpox until 1694, is more a clinical observer than 
a student of "epidemic constitutions"; and although his writings 
are of value to the epidemiologist, he does not help us to under- 
stand the circumstances in which epidemic diseases prevailed 
more at one time than another. To the end of the century there 
is no other medical source of information, and little besides 
generalities to be collected from any source. It is known that 
the years from 1693 to 1699 were years of scarcity all over the 
kingdom, that the fever-deaths in London reached the high 
figure of 5036 in 1694, and that there was a high mortality in 
many country parishes and market towns during the scarcity. 
But there are few particular illustrations of the type of epidemic 
sickness. There is, therefore, little left to do but to give the 
figures, and to add some remarks. 

Fever Deaths in the London Bills, 1687 — I7(X). 







Spotted 


Deaths 






Spotted 


Deaths 




Fever 


fever 


from all 




Fever 


fever 


from all 


Year 


deaths 


deaths 


causes 


Year 


deaths 


deaths 


causes 


1687 


2847 


144 


21460 


1694 


5036 


423 


24109 


1688 


3196 


139 


22921 


1695 


3019 


105 


19047 


1689 


3313 


129 


23502 


1696 


2775 


102 


18638 


1690 


3350 


203 


21461 


1697 


3III 


137 


20292 


169I 


3490 


193 


22691 


1698 


3343 


274 


20183 


1692 


3205 


161 


20874 


1699 


3505 


306 


20795 


1693 


32II 


199 


20959 


1700 


3675 


189 


19443 



44 Typhus and other Continued Fevers. 

Tables from Short^s Abstracts of Parish Registers. 





Registers 


Registers with 


Deaths 


Births 


Year 


examined 


excess of death 


in them 


in them 




Country Parishes 






1689 


144 


27 


828 


692 


i6go 


146 


17 


532 


324 


1691 


147 


16 


336 


180 


1692 


147 


10 


207 


146 


1693 


146 


27 


650 


426 


1694 


148 


18 


465 


348 


1695 


149 


23 


649 


492 


1696 


150 


19 


503 


344 


1697 


150 


21 


559 


409 


1698 


152 


12 


397 


289 


1699 


151 


20 


433 


318 


1700 


160 


29 


890 


739 




Market Towns. 






1689 


25 


12 


1965 


1415 


1693 


25 


5 


417 


338 


1694 


25 


6 


1307 


681 


1695 


^\ 


3 


309 


246 


1696 


26 


4 


1020 


708 


1697 


26 


2 


109 


80 


1698 


26 


4 


575 


423 


1699 


26 


7 


1181 


867 


1700 


27 


4 


726 


587 



In the London figures the year 1694 stands out conspicuous 
by its deaths from all causes, and by its high total of fevers. 
The fever-deaths began to rise from their steady weekly level 
a little before Christmas, 1693, and remained high all through 
the year 1694, with a good many deaths from "spotted fever" 
in the worst weeks. Among the victims in London in February 
was Sir William Phipps, Governor of New England : his illness 
appeared at first to be a cold, which obliged him to keep his 
chamber ; but it proved " a sort of malignant fever, whereof 
many about this time died in the city\" Pepys, writing to 
Evelyn on 10 August, 1694, calls it "the fever of the season," 
three being down with it at his house, but well advanced in 
their recovery. In that week and in the week following, the 
deaths in London from all causes touched the highest points of 
the year, the deaths from fever and spotted fever being a full 
quarter of them. Fever at its worst in London never made more 
than a quarter of the annual deaths from all causes ; so that, if 

^ Cotton M7i.i\\&x\ Magiialia. Ed. of 1853, '• '^'^T- 



Epidemic of Fever in London, 1694. 



45 



we take it to have been the successor of the plague, it operated 
in a very different way — with a greatly lessened fatality of all 
that were attacked, with only a reminder of the old special 
incidence upon the summer and autumn seasons, but with a 
steadiness from year to year, and throughout each year, that 
made the fever-deaths of a generation little short of one of those 
enormous totals of plague-deaths that were rapidly piled up 
during a few months, perhaps once or twice in a generation. 

The following table from the London weekly Bills shows the 
progress of the fever from the end of April, 1694, with the 
number of deaths specially assigned to "spotted fever": — 

London: Weekly Mortalities from fever and all causes^ epidemic of 1694. 



Week 




Spotted 


All 


Week 




Spotted 


All 


ending 


Fever 


fever 


deaths 


ending 


Fever 


fever 


deaths 


April 24 


90 


15 


427 


Aug. 


28 


III 


20 


510 


May I 


n 


10 


369 


Sept. 


5 


115 


16 


505 


8 


89 


9 


413 




12 


112 


12 


462 


15 


80 


5 


395 




18 


98 


9 


504 


22 


lOI 


3 


428 




25 


106 


4 


490 


29 


72 


8 


430 


Oct. 


2 


124 


8 


533 


June 5 


112 


12 


469 




9 


125 


10 


553 


12 


113 


12 


434 




16 


114 


9 


552 


19 


113 


II 


430 




23 


104 


3 


511 


26 


99 


14 


396 




30 


118 


3 


528 


July 3 


94 


II 


423 


Nov. 


6 


70 


3 


439 


10 


89 


7 


453 




13 


106 


2 


471 


17 


86 


10 


445 




20 


117 


13 


538 


24 


115 


13 


507 




27 


79 


6 


456 


31 


84 


13 


484 


Dec. 


4 


87 


6 


475 


Aug. 7 


99 


10 


462 




II 


87 


3 


407 


14 


no 


20 


530 




18 


78 


4 


445 


21 


135 


19 


583 




25 


66 


3 


394 



The year 1694, to which the epidemic of malignant fever 
(as well as malignant smallpox) belongs, was one of the series 
of "seven ill years" at the end of the 17th century (1693-99). 
They were long noted, says Thorold Rogers, " for the distress of 
the people and for the exalted profits of the farmer." The price 
of wheat in the autumn and winter of 1693 was the highest since 
the famine of 166 1. In 1697-8 corn was again dear and much 
of it was spoilt. At Norwich in 1698 wheat was sold at 44^. a 
comb. 

Harvests spoiled by wet weather or unseasonable cold appear 
to have been the most general cause of the high prices of food. 
In London there was no unusual sickness except in 1694; indeed 
the other years to the end of the century show a somewhat low 



4-6 Typhus a?id other Contimied Fevers. 

mortality, the year 1696, which Macaulay marks as a time of 
severe distress among the common people owing to the calling 
in of the debased coinage ^ had the smallest number of deaths 
from all causes (18,638) since many years before, and for a 
century after allowing for the increase of population. But the 
deaths from " fever " were some three thousand every year, and 
the births, so far as registered, were, as usual, far below the 
deaths. 

It was in the country at large that the effects of the " seven 
ill years" were chiefly felt. According to Short's abstracts of 
parish registers, there was unusual mortality at the beginning of 
the period and at the end of it ; in his Chronology he mentions 
spotted fever, bloody flux and agues in 1693 (besides an influenza 
or universal slight fever recorded by Molyneux of Dublin), and 
again in 1697 and 1698 "purples, quinsies, Hungarian and 
spotted fever, universal pestilential spotted fever," from famine 
and bad food. 

When we look for the evidence of this in England we shall 
have difficulty in finding it. Short's own abstracts give almost 
no colour to it ; but there are other figures from the parish 
registers, scattered through the county histories and statistical 
works, which prove that the seven ill years must have checked 
population. Thus at Sheffield in the ten years 1 691-1700 there 
was the greatest excess of burials over baptisms in the whole 
history of the town from 1561 — namely, 2856 burials to 2221 
baptisms (688 marriages). At Minehead, Somerset, a parish of 
some 1200 people occupied in weaving, the deaths and births 
were as follows in four years of the decennium : 





Baptised. 


Buried. 




Baptised. 


Buried. 


I69I 


57 


75 


1695 


47 


48 


1694 


34 


55 


1697 


35 


65 



A glimpse of spotted or pestilential fever in Bristol during 
the years of distress at the end of the 17th century comes from 
Dr Dover, a man of no academical repute, but at all events an 
articulate voice. Passing from an account of the spotted pesti- 
lential fever at Guayaquil, " when I took it by storm," he goes 
on^: 

1 History of England &=€., IV. 707. Evelyn {Diary, 11 May, 1696) says the city 
was "very healthy," although the summer was exceeding rainy, cold and unseason- 
able. 

2 Thomas Dover, M.R., T/ie Ancient Physician'' s Legacy. London, i73'2, p. 98. 



The Seven III Years, 1693-99, ^'^^ England. 47 

"About thirty-seven years since [written in 1732], this fever raged much 
in Bristol, so that I visited from twenty-five to thirty patients a day for 
a considerable time, besides their poor children taken into their workhouse, 
where I engaged myself, for the encouragement of so good and charitable an 
undertaking, to find them physick and give them advice at my own expense 
and trouble for the two first years. All these poor children in general had 
this fever, yet no more than one of them died of it of the whole number, 
which was near two hundred." 

— an experience of typhus in children which was strictly 
according to rule. This had clearly been the occasion of a 
memorial addressed to the Mayor and Aldermen of Bristol, in 
1696, praying that a capacious workhouse should be erected for 
children and the aged, which " will prevent children from being 
smothered or starved by the neglect of the parish officers and 
poverty of their parents, which is now a great loss to the 
nation \" 

The year 1698 was the climax of the seven ill years. The 
spring was the most backward for forty-seven years, the first 
wheat in the ear being seen near London on i6th June. For 
four months to the end of August the days were almost all 
rainy, except from the i8th to the 26th July. Whole fields 
of corn were spoilt. In Kent there was barley standing uncut 
on 29th September, and some lay in the swathe until December. 
Much of the corn in the north of England was not got in until 
Christmas, and in Scotland they were reaping the green empty 
corn in January I 

Fevers of the seven ill years in Scotland. 

It is from Scotland that we hear most of the effects of the 
seven ill years in the way of famine and fever. Scotland was 
then in a backward state compared with England ; and its 
northern climate, making the harvest always a few weeks later 
than in England, told especially against it in the ill years. 
Fynes Morryson, in the beginning of the 17th century, contrasts 
the Scotch manner of life unfavourably with the English, and 
Sir Robert Sibbald's account towards the end of that century is 
little better. Morryson says, " the excesse of drinking was then 
farre greater in generall among the Scots than the English." 
Sibbald remarks^* on the drinking habits of the Scots common 

'^ Broadsheet in the British Museum Library. 

- Tooke, Hist, of Pnces, Introd. 

^ Scotia Illustrata. Edin. 1684. Lib. Ii. p. 52. 



48 Typhus and other Continued Fevers. 

people : their potations of ale or spirits on an empty stomach, 
especially in the morning, relaxed the fibres and induced 
"erratic fevers of a bad type, bastard pleurisies,... dropsies, 
stupors, lethargies and apoplexies." Morryson says: "Their 
bedsteads were then like cubbards in the wall, with doores to be 
opened and shut at pleasure, so as we climbed up to our beds. 
They used but one sheete, open at the sides and top, but close 
at the feete, and so doubled \" Sibbald says the peasantry had 
poor food and hard work, and were subject to many diseases 
— "heartburn, sleeplessness, ravings, hypochondriac affections, 
mania, dysentery, scrophula, cancer, and a dire troop of diseases 
which everywhere now invades the husbandmen that were 
formerly free from diseases." Causa a victu est. Therefore 
consumption was common enough. He has much to say of 
fevers, — of intermittents, especially in spring and autumn, ca- 
tarrhal fevers, nervous fevers, comatose fevers, with delirium, 
spasms and the like symptoms, malignant, spotted, pestilential, 
hectic, &c. The continued fevers ranged in duration from fifteen 
to thirty-one days, recovery being ushered in with sweats, alvine 
flux and salivation. Purple fevers had sometimes livid or black 
spots mixed with the purple (mottling) ; in a case given, there 
were suppurations which appear to have been bubonic. There 
had been no plague in Scotland since 1647-48 ; but fevers, unless 
Sibbald has given undue prominence to them, would appear to 
have filled its place among the adults. 

Another writer of this period, from whom some information 
is got as to fevers, was Dr Andrew Brown of Edinburgh. He is 
mainly a controversialist, and is on the whole of little use save 
for the history of the treatment of fevers. He came to London 
on a visit in 1687, attracted by the fame of Sydenham's method 
of curing fevers by antimonial emetics and by purgation : 
" Returning home as much overjoyed as I had gotten a treasure, 
I presently set myself to that practice " — of which he gave an 
account in his ' Vindicatory Schedule concerning the New Cure 
of Fever^.' Continual fever, he says, takes up, with its pendicles, 
the half of all the diseases that men are afflicted with ; and some 
part of what he calls continual fever must have been spotted : 
" As concerning the eruption of spots in fevers, these altogether 
resemble the marks made by stroaks on the skin, and these 

' Fynes Morryson, Ilincrary, 1614. Pt. in. p. 156. 
'•^ Edinburgh, 1^91, \>. 67. 



Dr Andrezv Brown on Fevers in Scotland, 1699. 49 

marks are also made by the stagnation and coagulation of the 
blood in the small channels [according to the doctrine of ob- 
structions] They tinge the skin with blewness or redness." 

The bitter controversy as to the treatment of fevers led Brown 
into another writing in 1699^ 

" The fevers that reign at this time [it was towards the end of the seven 
ill years] are for the most part quick and peracute, and cut off in a few days 
persons of impure bodies. And as I have used this method by vomiting 
and purging in many, and most successfully at this time, so I have had 
lately considerable experience thereof in my own family : wherein four of 
my children and ten servants had the fever, and blessed be God, are all 
recovered, by repeated vomiting with antimonial vomits and frequent 
purgings, except two servants, the one having gotten a great stress at work, 
who bragging of his strength did contend with his neighbour at the mowing 
of hay, and presently sickened and died the sixth day, and whom I saw not 
till the day before he died, and found him in such a condition that I could 
not give him either vomit or purge : and the other was his neighbour who 
strove with him, being a man of most impure and emaciate body, who had 
endured want and stress before he came to my service, and who got not all 
was necessary because he had not the occasion of due attendance, all my 
servants being sick at the timel" 

This account of the experience which Dr Andrew Brown had 
lately had among his children and domestics in or near Edin- 
burgh was written in 1699, and may be taken as relating to part 
of the wide-spread sickliness of the seven ill years in Scotland. 
Fletcher of Saltoun gives us a general view of the deplorable 
state of Scotland at the end of the 17th century, which was 
intensified by the succession of bad harvests -l The rents of 
cultivated farms were paid, not in money, but in corn, which 
gave occasion to many inequalities, to the traditional fraudulent 
practices of millers and to usury. The pasture lands for sheep 
and black cattle had no shelters from the weather, and no winter 
provision of hay or straw (roots were unheard of until long after), 
" so that the beasts are in a dying condition." The country 
swarmed with vagrants (a hundred thousand, he estimates, in 
ordinary times, but doubled in the dear years), who lived and 
multiplied in incest, rioted in swarms in the nearest hills in times 
of plenty, and in times of distress fell upon farmhouses in gangs 

^ The Epilogue to the Five Papers, etc. Edin. 1699, p. 22. This title refers to a 
controversy on the use of antimonial emetics in fevers. See Dr John Brown's essay 
on Dr Andrew Brown, in his Locke and Sydenham, new ed. Edinb., 1866. 

^ He adds that " the fever has several times before been in my family and among 
my servants and children." In mentioning the case of the Master of Forbes in 
August, 1 69 1, whom he cured, he remarks that " the malicious said he was under no 
fever " ; to disprove which Dr Brown refers to the symptoms of frequent pulse, 
watching and raving, continual vomiting, frequent fainting, and extreme weakness. 

"' Andrew Fletcher, Two Discourses. 1699. 

C. 11. - ' 4 



50 TypJnis and other Contiimed Fevers. 

of forty or more, demanding food. Besides these there were a 
great many poor families very meanly provided for by the 
Church boxes, who lived wholly upon bad food and fell into 
various diseases. He had been credibly informed that some 
families in the years of mere scarcity preceding the climax of 
1698-99 had eaten grains, for want of bread. " In the worst time, 
from unwholesome food diseases are so multiplied among poor 
people that, if some course be not taken, the famine may very 
probably be followed by a plague\" 

We owe some details of these calamities in Scotland to 
Patrick Walker, the Covenanter, who records them to show 
how the prophecies of Divine vengeance on the land, uttered 
during the Stuart persecutions by Cargill and Peden, had been 
in due time fulfilled ''': 

" In the year 1694, in the month of August, that crop got such a stroke 
in one night by east mist or fog standing like mountains (and where it 
remained longest and thickest the badder were the effects, which all our old 
men, that had seen frost, blasting and mildewing, had never seen the like) that 
it got little more good of the ground. In November that winter many were 
smitten with wasting sore fluxes and strange fevers (which carried many 
off the stage) of such a nature and manner that all our old physicians had 
never seen the like and could make no help ; for all things that used to be 
proper remedies proved destructive. And this was not to be imputed to 
bad unwholesome victual ; for severals who had plenty of old victual did 
send to Glasgow for Irish meal, and yet were smitten with fluxes and fevers 
in a more violent and infectious nature and manner than the poorest in the 
land, whose names and places where they dwelt I could instance. 

" These unheard-of manifold judgments continued seven years, not 
always alike, but the seasons, summer and winter, so cold and barren, 
and the wonted heat of the sun so much withholden, that it was discernible 
upon the cattle, flying fowls and insects decaying, that seldom a fly or gleg 
was to be seen. Our harvests not in the ordinary months, many shearing in 
November and December, yea some in January and February ; the names 
of the places I can instruct. Many contracting their deaths, and losing the 
use of their feet and hands, shearing and working amongst it in frost and 
snow ; and after all some of it standing still, and rotting upon the ground, 
and much of it for little use either to man or beast, and which had no taste 
or colour of meal. Meal became so scarce that it was at two shillings a 
peck, and many could not get it. 

"Through the long continuance of these manifold judgments deaths and 
burials were so many and common that the living were wearied with 
burying of the dead. I have seen corpses drawn in sleds. Many got neither 
coffins nor winding-sheet. 

" I was one of four who carried the corpse of a young woman a mile 
of way ; and when we came to the grave, an honest poor man came and 
said, ' You must go and help me to bury my son, he is lien dead this 

^ The English Government took off the Customs duty upon victual imported from 
England to Scotland, and placed a bounty of lod. per boll upon it. 

^ Patriclc Walker, Sonic Remarkable Passages in the Life and Death of Mr Daniel 
Cargill, i^c, Edinb. 1732. (Reprinted in Biographia Presbyteriaiia. Edinb. 1827, 
II. 25.) 



Sicknesses of the Seven III Years in Scotland. 51 

two days ; otherwise I will be obliged to bury him in my own yard.' We 
went, and there were eight of us had two miles to carry the corpse of that 
young man, many neighbours looking on us, but none to help us. I was 
credibly informed, that in the North, two sisters on a Monday's morning 
were found carrying the corpse of their brother on a barrow with bearing- 
ropes, resting themselves many times, and none offering to help them. 

"I have seen some walking about at sunsetting, and next day at six 
o'clock in the summer morning found dead in their houses, without making 
any stir at their death, their head lying upon their hand, with as great 
a smell as if they had been four days dead ; the mice or rats having eaten a 
great part of their hands and arms. 

"The nearer and sorer these plagues seized, the sadder were their effects, 
that took away all natural and relative affections, so that husbands had 
no sympathy with their wives, nor wives with their husbands, parents with 
their children, nor children with their parents. These and other things have 
made me to doubt if ever any of Adam's race were in a more deplorable 
condition, their bodies and spirits more low, than many were in these years." 

In the parish of West Calder, 300 out of 900 "examinable" persons 
wasted away. 

Some facts and traditions of the Seven 111 Years were recorded nearly a 
century after in the Statistical Account of Scotland. From the Kirk 
Session records of the parish of Fordyce, Banffshire, it did not appear " that 
any public measures were pursued for the supply of the poor, nor anything 
uncommon done by the Session except towards the end. The common 
distribution of the collections of the church amounted only to about \s. id. 
or IS. \d. weekly." The Kirk Session records bore witness to the numerous 
cases of immorality in the years before the famine that had been dealt with 
ecclesiastically, and to the entire and speedy cessation of such cases 
thereafter ^ 

The account for the parish of Keithhall and Kinkell, Aberdeenshire, says 
that "many died of want, in particular ten Highlanders in a neighbouring 
parish, that of Kemnay ; so that the Session got a bier made to carry them 
to the grave, not being able to afford coffins for such a number^." In 
the upland parish of Montquhitter, in the same county, the dear years 
reduced the population by one half or more. Until 1709 many farms were 
waste. Of sixteen families that resided on the estate of Lettertie, thirteen 
were extinguished. The account of this parish contains several stories 
of the distress, with the names of individuals''. It is clear, however, that all 
the parishes of Scotland were not equally distressed. The county of Moray 
and "some of the best land along the east coast of Buchan and Formartine 
[Aberdeenshire] abounded with seed and bread;" but transport to the 
upland parishes was difficult ■*. 

^ Sir John Smclo-ix^?, Statistical Account of Scotland, ist ed. III. 62. 

2 Ibid. II. 544. " Ibid. VI. 122. 

■* In the remote parish of Kilmuir, Skye, the famine is referred to the year 1688, 
"when the poor actually perished on the highways for want of aliment." {Ibid. 11. 
551.) In Duthil and Rothimurchus, Invernessshire, the famine is referred to 1680, 
"as nearly as can be recollected : " "A famine in this and the neighbouring counties, 
of the most fatal consequence. The poorer sort of people frequented the churchyard 
to pull a mess of nettles, and frequently struggled about the prey, being the earliest 
spring greens.... So many families perished from want that for six miles in a well- 
inhabited extent, within the year there was not a smoke remaining." (Ibid. IV. 316.) 
In the Kirk session records of the parish of Kiltearn, Rossshire, which I have seen in 
MS., there are various entries in the year 1697 relating to badges of lead to be worn by 
those licensed to beg from door to door: on 12 April, 34 such persons are named, 
and on 19 April, Robert Douglas was reimbursed for the cost of 35 badges. On 
2 Aug., the number of poor who were to receive each from the heritors ten shillings 
Scots reads like " nighentie foure." 

4-^2 



52 Typhus and other Contiiiued Fevers. 

We may take it that these experiences in the reign of 
WilHam III. were peculiar to Scotland; even Ireland, which had 
troubles enough of the same kind in the i8th and 19th centuries, 
was at that time resorted to as a place of refuge by the 
distressed Scots. Among the special and temporary causes in 
Scotland were antiquated agricultural usage, an almost incredible 
proportion of the people in a state of lawless vagrancy, such as 
Henry VIII. and Elizabeth had to deal with a century and a 
half before, a low state of morals, both commercial and private, 
a tyrannical disposition of the employers, a sullen attitude of the 
labourers, and a total decay of the spirit of charity. An ancient 
elder of the parish of Fordyce, who kept some traditions of the dear 
years, remarked to the minister: "If the same precautions had 
been taken at that time which he had seen taken more lately in 
times of scarcity, the famine would not have done so much hurt, 
nor would so many have perished." 

The evil of vagrancy, for which Fletcher of Saltoun saw no 
remedy but a state of slavery not unlike that which Protector 
Somerset had actually made the law of England for a couple 
of years, 1547-49, in somewhat similar circumstances, gradually 
cured itself without a resort to the practices of antiquity or of 
barbarism. 

The union with England in 1707, by removing the customs 
duties and opening the Colonial trade to Scots shipping (they 
had a share in the East India trade already) gave a remarkable 
impulse to the manufacture of linen and to commerce. Such 
was the demand for Scots linen that, it seemed to De Foe, " the 
poor could want no employment " ; and it may certainly be 
taken as a fact that the establishment on a free basis of 
industries and foreign markets gave Scotland relief from the 
pauperism and vagrancy, like those of Ireland in the i8th 
and 19th centuries, that threatened for a time, and especially 
in the Seven 111 Years, to retard the developement of the 
nation. 

For several years after the period of scarcity or famine 
from 1693 to 1699, the history of fever in Britain presents little 
for special remark. 

A book of the time was Dr George Cheyne's Neiu Theory of 
Continual Fever, London, 1701. His theory is that of Bellini 
and Borclli, which accounted for everything in fevers on 



Symptoms of the prevailing Fevers, 1700. 53 

mechanical principles, and ignored the infective element in 
them. Cheyne does not even describe what the fevers were ; 
but in showing how the theory applies, he mentions incidentally 
the symptoms — quick pulse, pain in the head, burning heat, 
want of sleep, raving, clear or flame-coloured urine, and morbid 
strength. Equally theoretical is the handling of the subject by 
Pitcairn. Freind, in his essays on fevers \ is mainly occupied 
with controversial matters of treatment, except in connexion 
with Lord Peterborough's expedition to Spain in 1705, as we 
shall see in a section on sickness of camps and fleets. 

In the absence of clinical details from the medical pro- 
fession, the following from letters of the time will serve a 
purpose : 

On 18 September, 1700, Thomas Bennett writes to Thomas 
Coke from Paris giving an account of the fever of Coke's 
brother : His fever is very violent upon him, and he has a 
hickup and twitchings in his face ; he is especially ill in the 
night, and has now and then violent sweats. He raved for 
eight days together and in all that time did not get an hour's 
sleep. He was attended by Dr Helvetius and other physicians. 
Lady Eastes, her son, and most of her servants are sick, but 
they are all on the mending hand ; her steward is dead of a high 
fever, having been sick but five days^ These are Paris fevers, 
the symptoms suggesting typhus, especially the prolonged vigil 
in one of the cases. It is to be remarked that they occurred 
among the upper classes ; and it appears that the universal 
fevers "of a bad type" in France in 171 2 did not spare noble 
houses nor even the palace of Louis the Greats 

The following from the London Bills will show the pre- 
valence of fever from year to year^. 



1 John Freind, M.D., Nine Commentaries on Fevers, transl. by T. Dale. London, 

1730- 

■^ Cal. Coke MSS. ii. 405. 

^ Joannes Turner, De Febre Britannica Anni i'ji2. Lond. 1713, p- 3- "Vera 
proxime elapso, per Gallias passim ingravescere coeperunt febres mali moris in 
nobiles domos, et regiam praecipue infestae ; qub Ludovicum Magnum ipsa infortunia 
ostenderent Majorem, et patientia Cliristianissima Maximum." 

* From London, on 25 February, 1701, we hear of the illness from a violent fever 
of Mr Brotherton, at his house in Chancery Lane ; he was member for Newton, and 
Mr Coke was advised to look after his seat. A letter of 18 April, 1701, from 
Chilcote, in Derbyshire, says that it has been a sickly time in these parts and that a 
certain lady and her daughter were both dead and to be buried the same day. In the 
same correspondence, cases of fever in London are mentioned on 18 June and 
4 December the same year (1701). Cai. Coke MSS. 11. 421, 424, 429, 441. 



54 TypJms and other Coutijiued Fevers. 





Dead of 


Dead of 


Dead of 


Year 


Fever 


Spo tted Fever 


all diseases 


I70I 


2902 


68 


20,471 


1.702 


2682 


SZ 


19,481 


1703 


3162 


74 


20,720 


1704 


3243 


61 


22,684 


1705 


3290 


41 


22,097 


1706 


2662 


54 


19,847 


1707 


2947 


42 


21,600 


1708 


2738 


62 


21,291 


1709 


3140 


118 


21,800 


1710 


4397 


343 


24,620 


171I 


3461 


142 


19,833 


1712 


3131 


96 


21,198 


1713 


3039 


102 


21,057 


1714 


4631 


150 


26,569 


I715 


3588 


161 


22,232 


1716 


3078 


100 


24,436 


1717 


2940 


137 


23,446 


1718 


3475 


132 


26,523 


1719 


3803 


124 


28,347 


1720 


3910 


66 


25,454 



The London fever of 1709-10. 

The "seven ill years" were followed by the fine summer 
and abundant harvest (although hardly more than half the 
breadth was sown) of 1699. Scarcity was not a cause of 
excessive sickness again until 1709-10; although the harvest 
of 1703 was unfavourable. The price of wheat in 1702 was 
25^-. 6d. per quarter, and continued low for a number of years, 
notwithstanding the war with France. In Marlborough's wars 
there were no war-prices for farmers, as in the corresponding 
circumstances a century after ; on the contrary, corn and produce 
of all kinds were so cheap that farmers had difficulty in paying 
their rents. The bounty of five shillings per quarter on exported 
wheat had given a great impulse to corn-growing, so that the 
acreage of wheat sown was much more than the country in an 
ordinary year required, partly, no doubt, because the bread of 
the poorer classes was largely made from the coarser cereals. 
The period of abundance was broken by the excessively severe 
winter of 1708—9, one of three memorable winters in the i8th 
century. The frost lasted all over Europe from October to 
March, and was followed by a greatly deficient crop in 1709. 
The following shows the rise of the price of the quarter of wheat 
in England : 



27 


3 


46 


3 


57 


6 


8i 


9 


8i 


9 



A case of the London Fever of 1709. 55 

s. d. 

1708 Lady-day 
„ Michaelmas 

1709 Lady-day 
„ Michaelmas 

1 7 10 Lady-day 
The export of corn was prohibited in 1709 and again in 17 10. 

An epidemic of fever began in London in the autumn of 
1709 and continued throughout 1710, in which year the 
fever-deaths reached the highest total since 1694. But it was 
not altogether a fever of starvation or distress among the poor, 
and perhaps not mainly so. There is always the dual question 
in connexion with fever following bad seasons and high prices : 
how much of it was due to the scarcity, and how much to those 
states of soil and atmosphere upon which the failure of the crop 
itself depended. An authentic case of the malignant fever 
which began to rage in London in the autumn of 1709 will both 
serve to show the remarkable type of at least a portion, if not 
the whole of the epidemic, and to prove its incidence upon 
the houses of the rich. 

The case is recorded by Sir David Hamilton^: 

"About the 5th of October, 1709, the son of that worthy gentleman, 
WilHam Morison, esquire, was seized with a fever ; at which time, and for 
some weeks before, a malignant fever raged in London." He had a quick 
and weak pulse, great difficulty or hindrance of speech, and a stupidity ; 
" whereto were added tremors, and startings of the tendons, a dry and 
blackish tongue, a high-coloured but transparent urine and coming away for 
the most part involuntarily, and a hot and dry skin." Dr Grew was called 
in, and prescribed alexipharmac remedies (cordials, sudorifics, etc.) " A 
few days after the patient's skin was stained or marked with red and purple 
spots, and especially upon his breast, legs and thighs. These symptoms, 
although a little milder now and then, prevailed for fourteen days ; after 
that the spots vanished, and the convulsive motions so increased that the 
young gentleman seemed ready to sink under them for several days 
together." He was treated with the application of blisters, and with doses 
of bark. His strength and flesh were so wasted that the hip whereon he 
lay was seized with a gangrene. For ten or twelve days before his death, 
" he breathed and perspired so offensive a smell that they were obliged to 
smoke his chamber with perfumes ; and even myself, whilst I inclined my 
body a little too near him, was, by receiving his breath into my mouth, seized 
all on a sudden with such a sickness and faintness that I was obliged to take 
the air in the open fields, and returning thence to drink plentifully of 
mountain wine at dinner." The examination after death was made by the 
celebrated anatomist Dr Douglas. There was still a heap of brown-coloured 
spots visible on the breast ; "there was nothing contained in the more 
conspicuous vessels of the abdomen but grumes or clots of blackish blood, 
without any serum in the interstices." Hamilton adds: "We too seldom 
dissect the bodies. of those dying in fevers." 

1 Tractat us Duplex. Lond. 1710. Engl, transl. 1737, p. 253. 



56 Typhus and other Contimied Fevers. 

The tremors, offensive sweats and ofifensive breath are 
distinctive of a form of typhus that became common towards 
the middle of the century, and was called putrid fever (not 
in the sense of Willis) or miliary fever from the watery vesicles 
of the skin that often attended it. But although Hamilton was 
writing on miliary fever (of the factitious variety) this case is 
not given as an example, but is appended to his sixteen cases 
of the latter, as an example of " a deadly fever with loss of 
speech from the beginning." Among earlier cases, those 
belonging to the epidemic of 1661 as described by Willis 
correspond closely with this case, which we may take as repre- 
senting part of the malignant fever that then raged in London. 
We have an anatomical record from each ; but in neither was 
there sloughing of the lymph-follicles of the intestine, or of the 
mesenteric glands, as in the enteric fever of our own time ; while 
in both there were red or purple spots on the breast or neck, 
and on the limbs. The "loss of speech from the beginning" 
suggests Sydenham's " absolute aphonia" in the comatose fever 
of iGji-jG, which resembled in other respects Willis's fever 
of the brain and nervous stock (mostly of children) in 1661. 
One of the synonyms of "infantile remittent" was "an acute 
fever with dumbness^" This seems to have been a common type 
of fever in the latter part of the 17th century and early part of 
the 1 8th. Some likeness to enteric fever may be found in it, but 
there is no warrant for identifying it with that fever. Its main 
features may be said to have been its incidence upon the earlier 
years of life, but not to the exclusion of adult cases, its remark- 
able ataxic symptoms, which led Willis to refer it to " the brain 
and nervous stock" (spinal cord), its comatose character, its 
spots, occasional miliary eruption, ill-smelling sweats and other 
foetid evacuations, its protracted course, and its hectic sequelae. 

The weekly bills of mortality in London bear little evidence 
of unusual prevalence of fever in 1709, except in the weeks 
ending 13 and 20 September, when the fever-deaths were 96 
and 75 (including "spotted fever"). But the unusual entry 
of "malignant fever" appears in three weekly bills, 19 July, 
9 August and 23 August, one death being referred to it on each 
occasion. It was in the summer and autumn of 17 10 that the 
fever reached a height in London, being attended with a very 

' W. Butler, M.D., A Treatise on I he Infantile Rcinittciit Fever. Lond. 1782. 



Case of Relapsing Fever in London, 1710. 57 

fatal smallpox. An essay on the London epidemic of 1710^ 
is interesting chiefly for recording a probable case of relapsing 
fever, a form which was almost certainly part of the great febrile 
epidemic in London in 1727-29. 

Mrs Simon, aged 20, had a burning fever, stifling of her breath, frequent 
vomiting and looseness, foul tongue, loss of sleep, restlessness, intermitting, 
low and irregular pulse. This terrible fever disappeared on the fourth day, 
and she thought herself recovered. But on the seventh day from her being 
taken ill the fever returned, she was light-headed, did not know her 
relatives, and was fevered in the highest degree. It looked like a malignant 
fever, but there were no spots. 

The following table shows the very high mortality from 
fever (as well as from smallpox) in the epidemic to which the 
above case belonged. 

London : Weekly deaths from fever, smallpox and all causes. 

1710. 



Week 


Dead of 


Dead of 


Dead of 


Dead of 


ending 


fever 


spotted fever 


smallpox 


all diseases 


May 2 


103 


[illegible] 


99 


571 


9 


90 


6 


60 


517 


16 


84 


7 


71 


502 


23 


93 


15 


71 


503 


30 


106 


II 


83 


550 


June 6 


93 


2 


98 


508 


13 


79 


8 


84 


509 


20 


106 


12 


99 


574 


27 


105 


IS 


86 


503 


July 4 


106 


7 


99 


482 


II 


107 


13 


97 


467 


18 


126 


16 


89 


509 


25 


109 


13 


105 


562 


Aug. I 


91 


12 


79 


444 


8 


92 


II 


72 


463 


15 


98 


10 


58 


459 


22 


105 


10 


63 


463 


29 


III 


16 


71 


495 


Sept. 5 


76 


4 


63 


414 


122 


107 


12 


57 


520 


'? 


1^5 


9 


83 


548 


26 


81 


II 


46 


456 


Oct. 3 


98 


9 


45 


469 


10 


79 


10 


49 


480 


17 


90 


5 


41 


477 


24 


107 


5 


45 


■ 470 


31 


106 


14 


51 


421 


Nov. 7 


71 


6 


55 


425 


14 


92 


2 


41 


390 


21 


70 


4 


25 


345 



1 Philip Guide, M.D., A Kind Warning to a Mtdtitude of Patients daily afflicted 
with different so7-ts of Fevers. Lond. 1710. 

^ One death from "malignant fever," two from scarlet fever. 



58 Typhus and other Continued Fevers. 

Throughout England, in country parishes and in towns, the 
first ten years of the i8th century were on the whole a period of 
good public health. In Short's abstracts of the parish registers 
to show the excess of deaths over the births, those years are as 
little conspicuous as any in the long series. It was a time when 
there was a great lull in smallpox, and probably also in fevers. 
The figures for Sheffield may serve as an example^ It will be 
seen from the Table that the burials exceeded the baptisms in 
every decade from the Restoration to the end of the century ; 
after that for twenty years the baptisms exceeded the burials, 
the marriages having increased greatly. 

Vital Statistics of Sheffield. 



Ten-year 








periods 


Marriages 


Baptisms 


Burials 


I 66 I — 70 


58s 


2086 


2266 


I 67 I — 80 


sv 


2240 


2387 


I 68 I — 90 


540 


2595 


2856 


1691 — 1700 


688 


2221 


2856 


1701^ — 10 


942 


3033 


2613 


1711 — 20 


991 


3304 


2765 



Of particular epidemics, we hear of a malignant fever at 
Harwich in 1709. Harwich was then an important naval 
station, and the fever may have arisen in connexion with 
the transport of troops to and from the seat of war, just as 
camp- and war-fevers appeared at various ports in the next war, 
1742-48. 

There were rumours of a plague at Newcastle in 1710, 
which were contradicted by advertisement in the London Gazette"-. 
But, as there was so much plague in the Baltic ports in 17 10 
it is possible that the Newcastle rumour may have been one of 
plague imported, and not a rumour suggested by the mortality 
from some other disease. 

^ Hunter's Hallamsliire, ed. Gatty. 

- Brand, Hist, of Nezvcastte, ii. 308. Swift writes to Stella on 8 December, 1710 : 
" We are terribly afraid of the plague ; they say it is at Newcastle. I begged Mr 
Harley [the Lord President] for the love of God to take some care about it, or we are 
all ruined. There have been orders for all ships from the Baltic to pass their 
quarantine before they land ; but they neglect it. You remember I have been afraid 
these two years." The orders referred to were probably the Order of Council of 
9 Nov. 1 7 10. Parliament met on the 25th Nov. and passed the first Quarantine Act 
(y Anne, cap. II.). Swift had a good deal to say with Ministers on many subjects, and 
it is not impossible, however aljsurd, that his liacl been the first suggestion to Harley 
of a f|uarantine law. I had purposed including a history of quarantine in Britain, 
but can find no convenient context for it. I shall therefore refer the reader to the 
historical sketch which I have appended to the Article "Quarantine" in the 
/iiiryiiopth'dia frritaiinica, ytli cd. 



_.iJ ;-..-., 4 1 ur lITt 

SCHCOl or ?.!lD!C!NI 
^AiH HtviVERSITV 
Fever in an Oxford College. — London Epidemic of 17 14 59 

To the same period of epidemic fever in London, about 
1709-10, belongs also a curiously localized epidemic in an 
Oxford college, which reminds one somewhat of the circum- 
stances of enteric fever in our time. It was told to Dr Rogers 
of Cork twenty-five or twenty-six years before the date of his 
writing (1734), by one who was a student at Oxford then : 
" There broke out amongst the scholars of Wadham College 
a fever very malignant, that swept away great numbers, whilst 
the rest of the colleges remained unvisited. All agreed that 
the contagious infection arose from the putrefaction of a vast 
quantity of cabbages thrown into a heap out of the several 
gardens near Wadham College^" 

The next epidemic of fever in London was in 17 14. Like 
that of 1 7 10, it followed a great rise in the price of wheat, 
or perhaps it followed the unseasonable weather which caused the 
deficient harvest. Before the Peace of Utrecht wheat in England 
was as low as '^'i^s. <^d. per quarter, in 1712, the peace next year 
sending it no lower than 30^'. But at Michaelmas, 17 13, it rose 
with a bound to 56^'. iid., doubtless owing to a bad harvest. 
The fever-deaths in London began to rise in the spring of 17 14, 
reaching a weekly total of 103 in the week ending 20 April. 
All through the summer and autumn they continued very high, 
the weekly totals exceeding, on an average, those of the year 
1 7 10, as in the foregoing table, and having corresponding large 
additions of " spotted fever." The deaths from all causes 
in 17 14 were a quarter more than those of the year before, 
the epidemic of fever being the chief contributor to the rise. 
This happened to be a very slack time in medical writing^ ; 
but, even in the absence of such testimony as we have for 
earlier and later epidemics of fever in London, we may safely 
conclude that the fever of 17 14 was of the type of pestilential or 
malignant typhus, beginning in early summer and reaching 
a height in the old plague season of autumn. 

A singular instance of what may be considered war-typhus 

1 Essay on Epidemic Diseases. Dublin, 1734, p. 34. 

^ Dr Guide, a Frenchman, who had been in practice in London for many years, 
says in his Kind Warning to a Multititde of Patients daily afflicted tvitk different sorts 
of Fevers (17 10) "the British physicians and surgeons are lately fallen into an 
unhappy and terrible confusion and mixture of honest and fraudulent pretenders." 
Another writer of 1710, Dr Lynn, quoted in the chapter on Smallpox, implies that 
physicians were taking an unusually cynical view of their business. The most 
interesting essay of the time on fevers is by J. White, M.D. {De recta Sanguinis 
Missione &^c. Lend. 1712), a Scot who had been in the Navy and afterwards in 
practice at Lisbon ; but it throws no light upon the London fevers. 



6o Typhis and other Contimied Fevers. 

belongs to the winter of 171 5-16. The political intrigues 
preceding and following the death of Queen Anne in 17 14 
culminated in the Jacobite rising in Scotland and the North of 
England in 1715. The Jacobites having been defeated at 
Preston on 13 November, prisoners to the number of 450 
were brought to Chester Castle on the Sunday night before 
December ist. A fortnight later (December 15th), Lady 
Otway writes of the 450 prisoners in the Castle : 

"They all lie upon straw, the better and the worse alike. The king's 
allowance is a groat a day for each man for meat, but they are almost 
starved for want of some covering, though many persons are charitable 
to the sick." The winter was unusually severe, the snow lying "a yard 
deep." Many prisoners died in the Castle by "the severity of the season," 
many were carried off by "a very mahgnant fever." On February i6th 
Lady Otway writes again : — " So much sickness now in our Castle that they 
dye in droves like rotten sheep, and be 4 or 5 in a night throne into the 
Castle ditch ffor ther graves. The feavour and sickness increaseth dayly, is 
begun to spread much into the citty, and many of the guard solidyers is 
sick, it is thought by inffection. The Lord preserve us ffrom plague and 
pestilence^!" 

Prosperity of Britain, 1715-65. 

The fifty years from 171 5 to 1765 were, with two or three 
exceptions, marked by abundant harvests, low prices and heavy 
exports of corn. This was undoubtedly a great time in the 
expansion of England, a time of fortune-making for the monied 
class, and of cheapness of the necessaries of life. 

The well-being and comfort of the middle class were 
undoubtedly great ; also there was something peculiar to 
England in the prosperity of towns and villages throughout 
all classes. In the very worst year of the period, the year 1741, 
Horace Walpole landed at Dover on the 13th September, 
having completed the grand tour of Europe. Like many others, 
he was delighted with the pleasant county of Kent as he posted 
towards London ; and on stopping for the night at Sittingbourne, 
he wrote as follows in a letter : 

" The country town delights me : the populousness, the ease, the gaiety, 
and well-dressed everybody, amaze me. Canterbury, which on my setting 
out I thought deplorable, is a paradise to Modena, Reggio, Parma, etc. I 
had before discovered that there was nowhere but in England the distinction 
of middling- people. I perceive now that there is peculiar to us middling 
houses: how snug they are'^!" 

^ Elizabeth, Lady Otway, to Benj. Browne, Dec. ist and 15th, 1715, and Feb. 16, 
1716. Hist. MSS. Com. x. pt. 4, p. 352 ; Hemingway's Hist, of Chester^ \\. 244. 
^ Letters, ed. Cunningham, i. 72. 



The Public Health in the years of Prosperity. 6i 

Our history henceforth has little to record of malignant 

typhus fevers, or of smallpox, in these snug houses of the 

middle class, although not only the middle class, but also the 

highest class had a considerable share of those troubles all 

through the 17th century. But the i8th century, even the most 

prosperous part of it, from the accession of George I. to the 

beginning of the Industrial Revolution in the last quarter 

or third of it, was none the less a most unwholesome period 

in the history of England. The health of London was never 

worse than in those years, and the vital statistics of some 

other towns, such as Norwich, are little more satisfactory. 

This was the time which gave us the saying, that God made 

the country and man made the town. Praise of rural felicity 

was a common theme in the poetry of the time, as in Johnson's 

London : 

"There every bush with nature's music rings, 
There every breeze bears health upon its wings." 

Both for the country and the town the history of the public 
health does not harmonize well with the optimist views of 
the 1 8th century. The historians are agreed that, under the 
two first Georges, during the ministries of Walpole, the 
Pelhams and Pitt, the prosperity of Britain was general. Adam 
Smith speaks of "the peculiarly happy circumstances of the 
country" during the reign of George II. (1727-60). Hallam 
characterizes the same reign as " the most prosperous that 
England had ever experienced." The most recent historian 
of England in the i8th century is of the same opinion \ 
The novels of Fielding give us the concrete picture of 
the period with epic fidelity, and the picture is of abundance 
and prodigality. Agriculture and commerce with the Colonies, 
India and the continent of Europe, were the sources of the 
country's wealth. Farming and stock-raising had been greatly 
improved by the introduction of roots and sown grasses. 

1 Lecky, History of England in the Eighteenth Century, vi. 204 : — •" All the 
evidence we possess concurs in showing that during the first three-quarters of the 
century the position of the poorer agricultural classes in England was singularly 
favourable. The price of wheat was both low and steady. Wages, if they advanced 
slowly, appear to have commanded an increased proportion of the necessaries of life, 
and there were all the signs of growing material well-being. It was noticed that 
wheat bread, and that made of the finest flour, which at the beginning of the period 
had been confined to the upper and middle classes, had become before the close of it 
over the greater part of England the universal food, and that the consumption of 
cheese and butter in proportion to the population in many districts almost trebled. 
Beef and mutton were eaten almost daily in villages." 



62 Typhus and other Continued Fevers. 

In some country parishes the baptisms were three times 
the burials. But the public health during this period will 
not appear in a favourable light from what follows. More 
particularly there were three occasions, about the years 17 1 8, 
1728 and 1 74 1, when a single bad harvest in the midst of 
many abundant ones brought wide-spread distress, with epi- 
demics of typhus and relapsing fever; from which fact it 
would appear that the common people had little in hand. 
Thorold Rogers, among economists, was of the opinion that the 
prosperity was all on the side of the governing and capitalist 
classes, that the labourers were in " irremediable poverty" and 
"without hope," and that the law of parochial settlement, with 
the artificial fixing of wages by the Quarter Sessions and 
the bonuses out of the poor-rates, had the effect of keeping the 
mass of the people on the land " in a condition wherein existence 
could just be maintained^" I shall not attempt an independent 
judgment in economics, but proceed to those illustrations of 
national v/ell-being which belong to my subject, leaving the 
latter to have their due weight on the one side of economical 
opinion or on the other. Besides the economical question there 
is of course also an ethical one. When the pinch came about 
1766, there was the usual diversity of opinion expressed on the 
" condition of England" problem, one holding that the labourers 
were unfairly paid, another that the nation had been made 
" splendid and flourishing by keeping wages low," and that the 
distress was due to "want of industry, want of frugality, want of 
sobriety, want of principle" among the common people at large. 
"If in a time of plenty," wrote one austere moralist, "the 
labourers would abate of their drunkenness, sloth, and bad 
economy, and make a reserve against times of scarcity, they 
would have no reason to complain of want or distress at any 
time"." But there must have been something wrong in the 
economics and morals of their betters if it were the case that 
the working class as a whole, and not merely a certain number 
of individuals in it, was drunken, thriftless and slothful. The 
familiar proof of this is the apathy of the Church, broken by the 
Methodist revival of religion. 

1 Six Centuries of Work and Wages, pp. 398—415. 
^ Genileinan's Magazine, 1766. 



Wmtriiigham on TypJms at York, 171 8-19. 63 



The epidemic fevers of 1718-19. 

In the fifty years from 171 5 to 1765, the three worst periods 
of epidemic fever in England and Scotland correspond closely 
to the three periods of actual famine and its attendant train of 
sicknesses in Ireland, namely, the years 1718-19, 1727-29, and 
1740-42. The three divisions of the kingdom suffered in 
common, Ireland suffering most. The first period, 1718-19, 
was an extremely slack tide in medical writing, insomuch that 
hardly any accounts of the reigning maladies remain, except those 
by Wintringham, of York, and Rogers, of Cork. The whole 
of the Irish history of fevers and the allied maladies is dealt 
with in a chapter apart. Of the Scots history, little is known 
for the first of the three periods beyond a statement that there 
was a malignant fever and dysentery in Lorn, Argyllshire, in 
January and February, 1717^ 

Wintringham gives the following account of the synochiis, 
afterwards called typhus, which attracted notice in the summer 
of 17 1 8 and became more common in the warm season of 
17 19: in each year it began about May, reached its height 
in July and lasted all August, carrying off many of those 
who fell into it. 

It began with rigors, nausea and bilious vomiting, followed by alternate 
heats and chills, with great lassitude and a feeling of heaviness : then thirst 
and pungent heat, a dry and brown tongue, sometimes black. The patient 
slept little, did not sweat, and was mostly delirious, or anxious and restless, 
tossing continually in bed. About the 12th day it was not unusual for 
profuse and exhausting diarrhoea to come on. In a favourable case the 
fever ended in a crisis of sweating about the i6th day. Those who were of 
lax habit, unhealthy, hysteric, or cachectic, were apt to have tremors, spasms 
and deliriutn, while others were so prostrated as to have no control over 
their evacuations, lying in a stupor and raving when roused out of it. In 
these the fever would continue to the 20th day ; in some few it ended 
without a manifest crisis, and with a slow convalescence-. 

This applies to the city of York, but in what special 
circumstances we are not told. However, it happens that a 
physician of York, two generations after, in giving an account 
of the great improvement that had taken place in its public 
health, throws some light on its old-world state : " The streets 

1 Short. 

^ Clifton Wintringham, M.D., Conimentaruun nosologicum, morhos epidemicos et 
aeris variationes in tirbe Eboracensi locisque vicinis ab anno 17 15 usqite adfinem anni 
i'j2^ gi'assantes, complectens. Londini, 1727. 



64 Typhis and other Continued Fevers, 

have been widened in many places by taking down a number of 
old houses built in such a manner as almost to meet in the 
upper stories, by which the sun and air were almost excluded in 
the streets and inferior apartments \" 

In London the fever-deaths, with the deaths from all causes, 
rose decidedly in 1718, and reached a very high iigure in 17 19, 
of which the summer was excessively hot. One cause, at least, 
was want of employment, especially among weavers in the East 
End-. But the epidemic fever of 1718-19 was not limited 
to the distressed classes ; we have a glimpse of it, under 
the name of " spotted fever," in the family of the archbishop 
of Canterbury : 

" On Friday night the archbishop of Canterbury's sixth 
daughter was interred in our chancel, with four others preceding, 
she dying on Monday after three days of the spotted fever. 
The fourth and seventh are recovered, and hoped past 
danger^" 

The following table shows the fever-mortalities for London, 
from 17 1 8 onwards, and, for comparison, the excessive mortalities 
in the epidemics of 1710 and 1714 : 

1 W. White, M.D., Phil. Trans. LXXii. (1782), p. 35. The annual deaths under 
the old regime exceeded by a good deal the annual births : in the seven years 
1728 — 35, according to the figures from the parish registers in Drake's Elwraaim, 
the burials from all causes were 3488, and the baptisms 2803, an annual excess of 98 
deaths over the births in an estimated population of 10,800 (birth-rate 37 per 1000, 
death-rate 46 per 1000). But in the seven years, 1770 — 76, the balance was the 
other way : the population had increased by two thousand (to 12,800), and the births 
were on an average 20 in the year more than the deaths (474 births, 454 deaths), the 
birth-rate being still 37 per 1000, and the death-rate fallen to 35 per 1000. But the 
correctness of these rates depends on the population being exactly given. 

^ " There has been very great mobbing by the weavers of this town, as they 
pretend, because they are starved for want of trade ; and they pull the calico cloaths 
off women's backs wherever they see them. The Trainbands have been up since last 
Friday, and they were forced to fire at the mobb in Moor Fields before they would 
disperse, and four or five were shott and as many wounded." (Benjamin Browne to 
his father, 16 June, 1719: Mr Browne's MSS. Hist. MSS. Com. x. pt. 4, p. 351.) 
The calicoes which the London weavers tore from the backs of women were doubtless 
the Indian fabrics brought home by the ships of the East India Company. These 
imports were so injurious to home manufactures that an Act had been passed in 1700 
prohibiting (with some exceptions) the use in England of printed or dyed calicoes or 
any other printed or dyed cotton goods. This prohibition was re-enacted in 1721, 
two years after the rioting at Moorfields. (7 Geo. I. cap. 7). Blomefield (Hist, 
of A^orjo/k, in. 437) says that at Norwich also there was tearing of calicoes, "as 
pernicious to the trade" of that city. On the 20th of September, 1720, a great riot 
arose there, the rabble cutting several gowns in pieces on women's backs, entering 
shops to seize all calicoes found there, beating the constables, and opposing the 
sheriff's power to such a degree that the company of artillery had to be called 
out. 

^ Ambrose Warren to Sir P. Gell, 16 Sept. 1718, Hist. MSS. Com. ix. pt. 2, p. 
400 /'. 



The Fever Years 1718-20. 65 

London Mortalities from Fever, &=c. 



Year 


Fevers 


Spotted fevers 


Smallpox 


All causes 


I71O 


4397 


343 


3138 


24620 


1714 


4631 


150 


2810 


26569 


1718 


3475 


132 


1884 


26523 


1719 


3803 


124 


3229 


28347 


1720 


3910 


46 


1442 


25454 


172I 


3331 


84 


2375 


26142 


1722 


3088 


22 


2167 


25750 


1723 


3321 


51 


3271 


29197 


1724 


3262 


84 


1227 


25952 


1725 


3277 


59 


3188 


25523 


1726 


4666 


84 


1569 


29647 


1727 


4728 


102 


2379 


28418 


1728 


4716 


r 94 


2105 


27810 


1729 


5235 


[The entry 


2849 


29722 


1730 


401 1 


ends.] 


I914 


26761 


^1Z^ 


3225 




2640 


25262 


1732 


2939 




1 197 


23358 


1733 


3831 




1370 


29233 


1734 


3116 




2688 


26062 


^IZS 


2544 




1594 


23538 


1736 


3361 




3014 


27581 


1737 


4580 




2084 


27823 


1738 


3890 




1590 


25825 


1739 


3334 




1690 


25432 


1740 


4003 




2725 


308 1 1 



In country parishes, according to Short's abstracts of 
registers, there was no unusual sickness in 171 8 and 17 19. But 
in market towns the mortaHty rose greatly in 17 19, which had 
an excessively hot summer; and that was the year when the 
synochus or typhus described by Wintringham reached its worst 
at York. The mortality kept high for several years after 17 19. 







Market 


Towns. 








Registers 


Registers 


; with 


Deaths 


Births 


Year 


examined 


excess of deaths 


in same 


in same 


1716 


30 


8 




1060 


845 


1717 


30 


9 




1485 


1290 


I718 


30 


3 




249 


169 


I719 


30 


6 




1737 


1320 


1720 


30 


10 




2186 


1461 


172I 


33 


9 




1294 


952 


1722 


33 


II 




1664 


1345 


1723 


:->z 


14 




2532 


2176 



The high mortalities in 1721-23 were mostly from smallpox, 
exact figures of many of the epidemics in Yorkshire and else- 
where being given in the chapter on that disease. The country 
parishes shared in its prevalence : 

C. II. . 5 



66 



TypJms and other Continued Fevers. 



Year 
172I 
1722 
1723 



Country Parishes. 



Registers 
examined 

174 



Registers with 
excess of deaths 

35 
35 
63 



Deaths 

in same 

793 
1015 
2021 



Births 

in same 

586 

775 
1583 



Besides smallpox, diarrhoeas and dysenteries in the autumn 
are given by Wintringham as the reigning maladies, fever not 



being mentioned. 



The Epidemic Fevers of 1726-29 

Fever. 



evidence of Relapsing 



The four years 1726-29 were a great fever-period in London, 
the deaths having been as follows : 

Year Fever deaths All deaths 

1726 4666 29,647 

1727 4728 28,418 

1728 4716 27,810 

1729 5335 29,722 

In the last of those years the entry in the annual bills 
becomes "fever, malignant fever, spotted fever and purples." 

The following are the weekly maxima of fever deaths and 
deaths from all causes during the four years, 1726-29; in nearly 
all the weeks the deaths from " convulsions " (generic name for 
most of the maladies of infants) contribute from a fourth to a 
third, or even more, of the whole mortality. 



1726 



1727 



Week 


Fever 


All 


ending 


deaths 


deaths 


Jan. 


18 


71 


633 


March 


IS 


81 


678 


May 


31 


103 


611 


June 


7 


106 


607 


Aug. 


30 


102 


711 


Sept. 


6 


116 


680 




13 


109 


643 




20 


109 


648 


Aug. 


8 


103 


577 




15 


123 


698 




22 


132 


730 




29 


130 


789 


Sept. 


5 


150 


764 




12 


134 


795 




19 


165 


798 




26 


163 


715 


Oct. 


3 


150 


684 



1728 



Week 


Fever 


All 


ending 


deaths 


deaths 


Feb. 6 


112 


748 


13 


131 


889 


20 


121 


850 


27 


145 


927 


March 5 


93 


733 


Aug. 27 


138 


525 


Sept. 3 


131 


562 


Dec. 10 


122 


734 


Sept. 9 


109 


676 


Nov. 4 


213 


908* 


II 


267 


993* 


18 


166 


783 


Dec. 9 


132 


779 



1729 



* The sudden rise was due to influ- 
enza ; but the fever mortaUty was high 
for weeks before and after. 



The ''Little Feverr 67 

These are high mortalities, whatever were the types of fever 
that caused them. That the old pestilential fever of London 
was one of them we need have no doubt. Dr John Arbuthnot, 
writing two or three years after, said, " I believe one may safely 
affirm that there is hardly any year in which there are not in 
London fevers with buboes and carbuncles [the distinctive 
pestilential marks] ; and that there are many petechial or spotted 
fevers is certain \" 

The essay of Strother also has a reference to "spotted fever" 
in its title, although the text throws very little light upon it^. 
But, for the rest, the "constitution" of 1727-29 is more than 
usually perplexing. There was an influenza at the end of 1729, 
which can be separated from the rest easily enough by the help 
of the London weekly bills of mortality ; and it is probable, 
unless Arbuthnot, Huxham and Rutty have erred in their dates, 
that one or more epidemics of catarrhal fever had occurred 
before that, in the years 1727 and 1728. The greatest difficulty 
is with a certain "little fever," or "hysteric fever," or "febricula," 
which gave rise to some writing and a good deal of talk. 
Strother does not specially treat of it, at least under that name, 
although he says that " many, especially women, have been 
subject to fits of vapours, cold sweats, apprehensions, and un- 
accountable fears of death ; every small disappointment dejected 
them, tremblings and weakness attended them," etc. (p. 116); 
and again, " never was a season when apoplexies, palsies and 
other obstructions of the nerves did prevail so much as they do 
at present, and have done for some time past" (p. 102); while 
he had frequently seen hysterical and hypochondriacal symptoms, 
dejection of spirits and the like remaining behind the fever 
(p. 109). For some years before this, much had been heard in 
London of the vapours, the " hypo," the spleen, and the like, an 
essay by Dr Mandeville, better known by his ' Fable of the Bees,' 
having first made these maladies fashionable in the year 171 1 1 

^ John Arbuthnot, M.D., Essay concerning the Effects of Air on Human Bodies. 
Lond. 1733, p. 187. 

^ Edward Strother, M.D., Practical Observations on the Epidemical Fever which 
hath reigned so violently these tzvo years past and still rages at the present time, with 
some incidental remarks shewing whe^'ein this fatal Distemper differs from Common 
fevers ; and more particularly why the Bark has so often failed : and methods p7'escribed 
to render its use more effectual. In which is contained a very remarkable History of a 
Spotted Fever. London, 1729. This book was written before the influenza of the 
end of 1729. At p. 126 the author was writing on the 24th of May, 1728. The 
preface is undated. 

•^ Bernard de Mandeville, M.D., A Treatise of the Hypochondriack and Hysteric 
Diseases, 3rd ed. 1730, ist ed. 1711. It contains nothing about the " little fever." 

5—2 



68 Typhus and other Continued Fevers. 

In due time it began to be noticed that symptoms which 
many physicians made light of as a " fit of vapours " were really 
the beginning of a fever. Dr Blackmore, in an essay on the 
Plague written in 1721, admitted the ambiguity : 

" For several days a malignant fever has so near a resemblance to one 
that is only hysterick, that many physicians and standers by, I am apt 
to believe, mistake the first for the last, and look upon a great and 
dangerous disease to be only the spleen, or a fit of the vapors, to the great 
hazard of the patient 1." 

In 1730, Dr William Cockburn, in a polemic against the 
physicians whom he styles " the academical cabal " (because 
they objected to his secret electuary for dysentery), professes 
to give a history of the mistakes of the faculty in London over 
this " little fever," or " hysteric fever," which often became 
dangerous^ : 

" The present fever, with a variation in some of its symptoms, has now 
subsisted twelve years [or since 17 18] not in England only, but all over 
Europe [Manningham says it was peculiarly English]. Few or no physicians 
suspected the reigning and popular disease to be a fever. Vapours, a 
nervous disease, and such general appellations it had from sundry physicians. 
Others, who discovered the fever, knew it was the low or slow fever, first 
mentioned by Hippocrates.... The last were represented as ignorant for calling 
the distemper a fever, and affixing to it the name 'low' or 'slow,' a slow 
fever being, in their adversaries' opinion, altogether unheard of among 
physicians and never recorded in their books. Nothing was more monstrous 
than calling this distemper a fever, or confining persons afflicted with it to 
their bed, and dieting them with broth, or other liquid food of good 
nourishment, and what is easily concocted....' You are not hot, you are not 
dry ; you are in good temper ; and therefore you have no fever ' was the 
common language of the town.... They might have seen physicians practising 
for a destroying distemper, and yet, after seven years, they confess them- 
selves ignorant of its very name." 

At length, he continues, Blackmore admitted the ambiguity 
of diagnosis, while Mead, Freind and others, recognized that 
there was really such a thing as a slow, nervous fever, by no 
means free from danger to life. It is probably to this insidious 
fever that Strother refers : 

"Thus, having gone on for six or seven days in a train of indolence, they 
have been surprized on the seventh day, and have died on the eighth 
lethargick or delirious, whereas, if they had taken due care, the fever would 
have run its course in fifteen days or more." It was the remissions, or inter- 
missions, he explains, that often misled patients, by which he seems to mean 
the clear intervals between relapses. " Others, wearied out with relapses, 
have hoped their recovery would as certamly ensue as it had hitherto, and 

^ Richard Blackmore, M.D., A Discourse upon the Plague, ivith a prefatory accoiuit 
of Malignant Fever. London, 1721, p. 17. 

^ W. Cockburn, M.D., Danger of improving Physicl; tvith a h-ief account of the 
present Epidemick Fever. London, 1730. 



Relapsing Fever in London, 1727-29. 69 

have deferred asking advice until it was too late." These relapses, he 
thought, were brought on by venturing too soon into the air : " it is too 
well known that the fever has been cured, and patients have soon, after they 
have ventured into the air, relapsed and have again run the same circle of 
ill symptoms, if not worse than before." Bark failed conspicuously in these 
"remittents :" "it is therefore incumbent on me to examine into the reason 
of this fiew phetwmenon. 1 call it 7?^w," he explains, because bark had 
hitherto succeeded. "Perhaps we may find reason to lay some blame on the 
air for the frequent relapses.... Periodical comas have of late been common ; 
so soon as the fit was over, the drowsiness abated till the fit returned." 

Elsewhere he speaks of the frequent relapses as belonging to a "quartan," 
under which diagnosis bark had been tried. The fevers were less apt to 
"relapse" when treated by mild cathartics. Another symptom of this fever 
was jaundice : " If jaundice breaks forth on the fourth day of a fever, it is 
much better than if it comes at the conclusion of a fever.... Jaundices are now 
very common after the cure of these fevers." 

These indications, dispersed throughout the rambling essay 
of Strother, point somewhat plainly to relapsing fever \ But his 
theoretical pathology comes in to obscure the whole matter. 
He explains everything by obstructions. The jaundice was due 
to obstruction of the liver by " styptics," the hysteric symptoms 
to obstructions of the nerves; there were also theoretical obstruc- 
tions of the mesentery, part of the matter being sometimes 
"thrown off into the mesenteric glands" ; also "congestions" or 
phlegmons of the liver, spleen and pancreas. But it is when 
he comes to the bowels that his subjective morbid anatomy 
becomes truly misleading. There is nothing to show that 
Strother examined a single body dead of this fever. He says, 
however, in his a priori way : " The crisis of these slow fevers 
is generally deposited on the bowels... The lent fever is a 
symptomatical fever, arising from an inflammation, or an ulcer 
fixed on some of the bowels. A lent fever, depending on some 
fixed cause of the bowels, must be cured by having regard to 
those causes some of which I shall enumerate " : — the first sup- 
position being that the fever depends on phlegmons by con- 
gestion of " the liver, spleen, pancreas, or the mesentery " ; the 
second, if it depends on extravasations in an equally compre- 
hensive range of viscera ; the third, " if it depends on an ulcer, 
then all vulneraries must be administered internally ; but to 
speak truth, when the viscera are ulcerated, there remains but 
small hope of life " ; the fourth supposition is worms, the fifth 

1 I am the more persuaded of the identity with relapsing fever of much that was 
called remittent in Britain, and even intermittent, after reading the highly original 
treatise by R. T. Lyons on Relapsing or Famine Fever, London, 1872, relating to 
the epidemics of it in India. 



70 Typhus and other Con tinned Fevers. 

corruption of the humours. All this is paper pathology. There 
is not a single precise fact relating to ulcerated Peyer's patches, 
or to swollen mesenteric glands, or to enlarged spleen, which last 
would have been equally distinctive of relapsing as of enteric 
fever ; it is " the viscera " that are ulcerated, or congested, or 
extravasated, or it is " some of the bowels," or the pancreas and 
liver obstructed as well as the spleen, the obstruction of the liver 
being invoked to explain the highly significant jaundice. 

It is not quite clear whether Strother's fever with relapses 
and jaundice corresponded exactly to the little fever, hysteric 
fever, or nervous fever of the same years ; but it is worthy 
of note that relapsing fever in Ireland a century later was 
called febricula or the "short fever." It was not until 1746 
that the excellent essay upon it by Sir Richard Manningham 
was written. By that time a good deal was being said in 
various parts of Britain of a slow, nervous, or putrid fever, 
Huxham, in particular, identifying the nervous fever with Man- 
ningham's febricula or little fever\ Some have supposed that 
the nervous fever of the 1 8th century included cases of enteric 
fever, if it did not stand for that disease exclusively. Murchison 
takes Manningham's essay to be " an excellent description of 
enteric fever, under the title of febricula or little fever, etc.^" 
The following are brief extracts from his description, by which 
the reader will be able to form his own opinion on the question 
of identity^ 

At the beginning patients feel merely languid or uneasy, with flying 
pains, dryness of the lips and tongue but no thirst ; in a day or two they 
find themselves often giddy, dispirited and anxious without apparent reason, 
and passing pale urine. They have transient fits of chilliness, a low, quick 
and unequal pulse, sometimes cold clammy sweats and risings in the thi-oat. 
They go about until more violent symptoms come on, simulating those of 
quotidian, tertian or quartan fever ; sometimes the malady simulates pleurisy. 
There may be attacks of dyspnoea, nausea and haemorrhage ; the menses in 
women are checked. A loss of memory and a delirium occur at intervals for 
short periods. The malady is very difficult to cure and too often becomes 
fatal in the end. It will last thirty or forty days, unless it end fatally in 
stupor or syncope. A form of mania is a consequence of it, where it has 
been neglected or badly treated ; "of late years this species of madness has 
been more than ordinarily frequent." All sorts were liable to it, but mostly 
valetudinarians, delicate persons, and those in the decline of life ; the 

1 liuxham, 0)i Fevers, cliap. VI ii. 

- Murchison, Conliniied Fevers of Great B7-itain, 2nA ed. Lend. 1873, p. 4^.^- 

•' Sir Kichard Manningham, Kt., M.D. Febrieida or Little Fever, connnonly called 

the Nervous or Hysteric Fever, (fie Fever on the Spirits, Vapours, Hypo, or Spleen. 

1 746. 



The years 1727-29 tmhealthy in the country. 



71 



fatalities were "especially among the opulent families of this great 
metropolis 1." 

This fever-period in London corresponds on the whole 
closely with a series of unhealthy years in Short's tables from 
the registers of market towns and country parishes, and with 
high mortalities in the Norwich register. It was not specially 
a smallpox period, as the last unhealthy year, 1723, was. On 
the other hand the epidemiographists in Yorkshire, Devonshire 
and Ireland dwell most upon fevers of the nature of typhus, 
some of which were due to famine or dearth, and upon " agues." 







Market Towtis. 






Year 


Registers 
examined 


No. with excess 
of deaths 


Deaths 
in same 


Births 
in same 


1727 
1728 
1729 
1730 


34 
36 
36 


19 

23 
27 
16 

Norwich. 


3606 
4972 
6673 

3445 


2441 
2355 

3494 
2529 




Year 


Buried 


Baptized 






1728 
1729 


I417 
I73I 


774 
843 






Country Parishes. 




Year 


Registers 
examined 


With excess 
of burials 


Burials 
in same 


Baptisms 
in same 


1726 
1727 
1728 
1729 
1730 
I73I 


181 
180 
180 
178 
176 

175 


22 

55 
80 
62 

39 

24 


542 
1368 
2429 
2015 
1302 

700 


495 
1091 

1536 

1442 

1022 

614 



The best epidemiologists of the time were not in London, 
but at York, Ripon, Plymouth, Cork and Dublin. Leaving the 
Irish history to a separate chapter, we shall find in the annals 
of Wintringham, Hillary and Huxham a somewhat detailed 
account of the fevers which caused the very high mortalities of 
the years 1727-29, with an occasional glimpse of the circum- 
stances in which the fevers arose. Much of what follows relates 
to the same nervous, hysteric or " putrid " fever, with or without 
relapses, that has been described for London. Going back a 

^ It is clear that the nervous fever established itself as a distinct type in England 
in the earlier part of the i8th century, both in medical opinion and in common 
acceptation ; thus Horace Walpole, writing from Arlington Street on 28 January, 
] 760, says: "I have had a nervous fever these six or seven weeks every night, and 
have taken bark enough to have made a rind for Daphne : nay, have even stayed at 
home two days." Letters of Horace Walpole, ed. Cunningham, iii. 28 [. 



J 2 TypJius and other Contimted Fevers. 

little, Wintringham says^ that the continued fevers of 1720 were 
milder than those of the year before (which were synochus or 
typhus) and were often languid or nervous, with giddiness, stupor 
and nervous tremblings, a quick pulse, a whitish tongue, no thirst, 
and sweats of the head, neck and chest : this fever lasted twenty 
days or more, and ended in a general sweat. He had mentioned 
the "languid nervous fevers" first in the years 17 16 and 17 17, 
and he mentions them again as mixed with or following the 
synochus or typhus of 1727-28. 

In April, 1727, there were fevers prevalent, remitting and 
intermitting, but with uncertain paroxysms ; in May, a fever 
with pleuritic pains ; in July, a putrid fever in some, but the 
chief diseases of that month were "remittents and intermittents," 
which were often attended by cutaneous eruptions, sometimes of 
dusky colour and dry, at other times full of clear serum ; which, 
" as they depended upon a scorbutic taint, tormented the sick 
with pruritus." The sick persons in these remittents were for 
the most part drowsy and stupid, especially during the paroxysm; 
the fevers were followed by lassitude, debility, languor of spirits 
and hysteric symptoms. 

Hillary^, who practised at Ripon, not far from Wintringham, 
at York, records in 1726 the prevalence of remittents and inter- 
mittents : " some had exanthematous eruptions towards the 
latter end of the disease, filled with a clear or yellowish water, 
which went or dried away without any other inconvenience to 
the sick but an uneasy itching for a few days" — ^just as Win- 
tringham had described a miliary fever for 1727. It is also 
under 1726 that he describes the same drowsy and nervous 
symptoms of Wintringham's summer fever of 1727: 

"Ancient and weak hysterical people had nervous twitchings and 
catchings, and were comatous and delirious ; some were very languid, sick 
and faint, and had tremors ; the young and robust, who had more full 
pulses, were generally delirious, unless it was prevented or taken off by 
proper evacuations and cooling medicines. 1 found blistering to be of very 
great service in this fever, and the sick were more relieved by it than ever I 
observed in any other fever whatever. People of lax, weak constitutions 
were very low and faint, and had frequent, profuse, partial sweatings, which 
most commonly were cold and clammy." Huxham also, at the other end of 
England, says that in October and November, 1727, a slow nervous fever 
attacked not a few ; and under the date of January, 1728, he confirms the 
Yorkshire experiences of the prevalence of angina. 

^ Comnieiilar. Nosol. u. s. 

- William Hillary, M.D., "An Account of the principal variations of the V^eather 
ami the concomitant Ejiidemical Diseases from 1726 to 1734 at Ripon." App. to 
Essay on (he Smallpox, J,oncl. 1 740. 



Fevers in Yorkshire, 1727-29. 73 

There can be little doubt that England in 1727 was already 
suffering in a measure from the distress that was acutely felt 
in Ireland ; it was much aggravated by the hard winter of 
1728-29^ but it had begun before that and was doubtless the 
indirect cause of the great prevalence of sickness. The exports 
of corn under the bounty system used to bring two or three 
millions of money into the country in a year. But in 1727 there 
was a debt balance of 70,757 quarters of wheat imported, and 
in 1728 the import exceeded the export by 21,322 quarters, the 
price rising at the same time from 4^-. to 8^'. per bushel I 
Under the year 1727 Hillary says : 

" Many of the labouring and poor people, who used a low diet, and were 
much exposed to the injuries and changes of the weather, died ; many of 
whom probably wanted the necessary assistance of diet and medicines." 
And after referring, under the winter of 1727-28, to the prevalence of a fatal 
suffocative angina, which fell, by a kind of metastasis, on the diaphragm or 
pleura, and sometimes on the peritoneum, he proceeds (p. 16) : — 

" Nor did any other method, which art could afford, relieve them : 
insomuch that many of the little country towns and villages were almost 
stripped of their poor people, not only in the country adjacent to Ripon, 
but all over the northern parts of the kingdom : indeed I had no certain 
account of what distempers those who were at a distance died of, but 
suppose they were the same as those which I have mentioned, which were 
nearer to us. Bleeding, pectora,ls with volatiles, and antiphlogistic diluters 
and blistering, were the most successful. I observed that very few of the 
richer people, who used a more generous way of living, and were not exposed 
to the inclemencies of the weather, were seized with any of these diseases 
at this time.... The quartans were very subject to turn into quotidians, 
and sometimes to continual, in which the sick were frequently delirious." 

The Yorkshire accounts by Wintringham and Hillary for the 
second year of this epidemic period, the year 1728, are very full, 
as regards the symptoms or types of the fevers ; but it would 
be tedious to cite them at length, and unnecessary to do so 
unless to answer the not inconceivable cavil that the fevers were 
not of the nature of typhus in one or other of its forms. The 
chief point is that the second year, towards Midsummer, brought 
a fever with the symptoms of synocJms, and not rarely marked 
with small red spots like fleabites or with purple petechiae. In 
the autumn of 1729, Hillary noticed a fever of a slow type, 
which might go on as long as thirty days and end without a 
perfect crisis — the nearest approach to enteric fever in any of 
the descriptions. For the same years, 1727-29, Huxham, of 

^ Brand, History of Newcastle, ii. 517, says that the magistrates of that town made 
a collection for the relief of poor housekeepers in the remarkably severe winter of 
1728-29, the sum raised being ^362. 18^. 

'^ Tooke, History of Prices from 1793 to 1837. Introd. chap. p. 40. 



74 Typhus and other Continued Fevers. 

Plymouth, describes languid fevers of the "putrid" type, with 
profuse sweating, followed by typhus of a more spotted type. 
Like the Yorkshire observer, Huxham mentions also " inter- 
mittents " as mixed with the continued fevers. 

The great prevalence of these fevers, "intermittents and other 
fevers," in the west of England in 1728-29 was known to 
Dr Rutty of Dublin, who speaks especially of " the neighbour- 
hoods of Gloucester and London, and very mortal in the country 
places, but less in the cities." This is confirmed by Dover : 

" I happened to live in Gloucestershire in the years 1728 and 1729, when 
a very fatal epidemical fever raged to such a degree as to sweep off whole 
families, nay almost whole villages. I was called to several houses where, 
eight or nine persons were down at a time ; and yet did not so much as lose 
one patient where I was concerned 1." 

Some of the cases of nervous or putrid fever in the epidemics 
of 1727-29 appear to have been marked by relapses in the 
country districts as well as in London. Huxham says under 
date of April, 1728, that those who had wholly got rid of the 
putrid fever were exceedingly apt to have relapses. Hillary 
does not mention relapses until March, 1733, when a fever, with 
many hysterical symptoms, which succeeded the influenza of 
that year, relapsed in several, "though seemingly perfectly 
recovered before." But he seems really to be contrasting re- 
lapsing fever and typhus when he points out that, whereas the 
inflammatory type of fever in the first year of the epidemic 
(1727) was greatly benefited by enormous phlebotomies, the 
fever patients in the two seasons following, when the fever was 
more of the nature of spotted typhus, could not stand the loss 
of so much blood, or, it might be, the loss of any blood ^ This 
was precisely the remark made by Christison and others a 
century later, when the inflammatory synocha, which often 
had the relapsing type very marked, changed to the spotted 
typhus. 

^ Ancient Physician^ s Legacy. Lond. 1733, p- 144- 

^ " In the year i^i"]" says Hillary, "I ordered several persons to lose 120 to 140 
ounces of blood at several times in these inflammatory distempers, with great relief 
and success ; whereas, in this winter [1728] I met with few, and even the strong and 
robust, who could bear the loss of above 40 or 50 ounces of blood, at three or four 
times ; but, in general, most of the sick could not bear bleeding oftener than twice, 
and then not to exceed 30 or 34 oz. at most, at two or three times ; and especially 
those who had been afflicted with, and debilitated by, the intermitting fever in the 
autumn before, — these could not bear blooding oftener than once, or twice at most, 
and in very small quantities too, though the acuteness of the pain, and the other 
symptoms in all, seemed at first to indicate much larger evacuations that way; but the 
first bleeding often sunk the pulse and strength of the patient so much that I durst 
not repeat it more than once, and in some not at all." Hillary, u. s. p. 26. 



Types of Fever in Scotland, 1731-35. 75 

From the year 173 1 we begin to have annual accounts (soon 
discontinued) of the reigning maladies in Edinburgh, on the 
same plan as Wintringham's, Hillary's and Huxham's, with 
which, indeed, they are sometimes collated and compared ^ The 
fevers of Edinburgh and the villages near were as various as 
those of Plymouth, according to Huxham, and singularly like 
the latter. Thus, in the winter of 1731-32, there was much 
worm fever, comatose fever, or convulsive fever among children, 
but not limited to children, marked by intense pain in the head, 
raving in some, stupor in others, tremulous movements, leaping 
of the tendons, and all the other symptoms described by Willis 
for the fever of 1661, a fatal case of October, 1732, in a boy of ten, 
recorded by St Clair one of the Edinburgh professors, reading 
exactly like the cases of Willis already given ^ St Clair's case, 
which was soon fatal, had no worms ; but in the general accounts, 
both for the winter of 1731-32 and the autumn of 1732, it is 
said that many of the younger sort passed worms, both teretes 
and ascarides, and recovered, the fatalities among children being, 
as usual, few. In March and April, 1735, there were again "very 
irregular fevers of children." Huxham records exactly the same 
"worm-fever" of children at Plymouth in the spring of 1734 — a 
fever with pains in the head, languor, anxiety, oppression of the 
breast, vomiting, diarrhoea, and a comatose state {ajfecUis 
soporosus), which attacked the young mostly, and was often 
attended by the passage of worms. He gives the same account 
of the seasons as Gilchrist — the years 1734 and 1735 marked 
by almost continual rains, the country more squalid than had 
been known for some years I 

But it is the nervous fever that chiefly engrosses attention 
both in Scotland and in England, In 1735, Dr Gilchrist, of 
Dumfries, made it the subject of an essay, returning to the 
subject a few years after*. " As our fever," he says, " seems to 
be peculiar to this age, it is not a little surprising that much 
more has not been said upon it." He is not sure whether its 
frequency of late years may not be owing to the manner of 
living (it was the time of the great drink-craze, which Huxham 

1 Edin. Med. Essays and Obs. I-VI. This annual publication was the original of 
the Transactions of the Royal Society of Edinburgh. 

2 Ibid. I. 40; II. 27; II. 287 (St Clair's case); IV. 
^ Huxham, De aere et inorbis. 

^ Ebenezer Gilchrist, M.D., "Essay on Nervous Fevers." Edin. Med. Essays 
and Obs. iv. 347, and VI. (or V. pt. 2), p. 505. 



"j^ Typhits and otJier Contiimed Fevers. 

also connects with the reigning maladies) and to a long course 
of warm, rainy seasons ; the winters for some years had been 
warm and open, and the summers and harvests rainy. It was 
only the poorer sort and those a degree above them who were 
subject to this fever ; he knew but few instances of it amongst 
those who lived well, and none amongst wine-drinkers. It was 
in some insidious in its approach ; those who seemed to be in no 
danger the first days for the most part died. In others the 
onset was violent, with nausea, heat, thirst and delirium. Among 
the symptoms were looseness, pains in the belly, local sweating, 
tickling cough, leaping of the tendons. Sometimes they were 
in continual cold clammy sweats ; at other times profuse sweats 
ran from them, as if water were sprinkled upon them, the skin 
feeling death cold. 

At Edinburgh, from October, 1735, to February, 1736, the 
fever became very common, and was often a relapsing fever. 

" The sick had generally a low pulse on the first two or three days, with 
great anxiety and uneasiness, and thin, crude urine. Delirium began 
about the fourth day, and continued until the fever went off on the seventh 
day. Sometimes the disease was lengthened to the fourteenth day. The 
approach of the delirium could always be foretold by the urine becoming 
more limpid, and without sediment.... A large plentiful sweat was the crisis 
in some. Others were exposed to relapses, which were very frequent, and 
rather more dangerous than the former fever 1." 

These evidences, beginning with Strother's for London in 
1728 and extending to the Edinburgh record of 1735, must 
suffice to identify true relapsing fever. In the chapter on Irish 
fevers we shall find clear evidence of relapsing fever in Dublin 
in 1739, before the great famine had begun. 

Huxham's account of the fevers at Plymouth, in Devonshire 
generally, and in Cornwall about the years 1734-36 is of the 
first importance. It is highly complex, owing to the prevalence 
of an affection of the throat, so that one part of the constitution 
is " anginose fever." This has been dealt with in the chapter 
on Scarlatina and Diphtheria. Another part was true typhus. 
In his account of the nervous fever we are introduced, as in the 
Yorkshire annals, 1726-27, to a phenomenon that was almost 
distinctive of the low, nervous or putrid fever from about 1750 
to 1760 or longer, namely, the eruption of red, or purple, or 
white watery vesicles, from which it got the name of miliary 
fever. Huxham's annals arc full of this phenomenon about the 

' Ibid. V. pi. 1 , |). _5o. 



Huxham on Fevers at Plymouth, 1735. *]*] 

years i734-36\ The red pustules, or white pustules, with 
attendant ill-smelling sweats, are mentioned over and over 
again. He thought them critical or relieving : " Happy was 
then the patient who broke out in sweats or in red pustules." 
These fevers are said to have extended to the country parts 
of Devonshire, after they had ceased in Plymouth, and to 
Cornwall in August, 1736. In Plymouth itself the type of 
fever changed after a time to malignant spotted fever, synochus, 
or true typhus. 

The malignant epidemic seemed to have been brought in 
by the fleet ; it had raged for a long time among the sailors 
of the fleet lying at Portsmouth, and had destroyed many 
of them. In March, 1735, it was raging among the lower 
classes of Plymouth. About the loth day of the fever, previously 
marked by various head symptoms, there appeared petechiae, 
red or purple, or livid or black, up to the size of vibices or 
blotches, or the eruption might be more minute, like fleabites. 
A profuse, clammy, stinking sweat, or a most foetid diarrhoea 
wasted the miserable patients. A black tongue, spasms, hiccup, 
and livid hands presaged death about the nth to 14th day. 
So extensive and rapid was the putrefaction of the bodies 
that they had to be buried at once or within twenty-four hours. 
It was fortunate for many to have had a mild sweat and a 
red miliary eruption about the 4th or 5th day; but for others 
the course of the disease was attended with great risk. In April 
the type became worse, and the disease more general. There 
was rarely now any constriction of the throat. Few pustules 
broke out ; but in place of them there were dusky or purple and 
black petechiae, and too often livid blotches, with which 
symptoms very many died both in April and May. In July 
this contagious fever had decreased much in Plymouth, and 
in September it was only sporadic there. With a mere reference 
to Hillary's account of somewhat similar fevers at Ripon in 
1734-5 (with profuse sweats, sometimes foetid, great fainting 
and sinking of spirits, starting of the limbs and beating of the 
tendons, hiccup for days, etc.^) we may pass to a more signal 
historical event, the great epidemic of fever in 1741-42, of which 
the Irish part alone has hitherto received sufficient noticed 

^ Obs. de aere et morbis ; also his essay On Fevers. 
^ Hillary, App. to Smallpox, 1740, pp. 57, 66. 

^ Mr. Lecky {History of England in the \%tk Century, 11.), says that the famine 
and fever of 1740-41, which he describes as an important event in the history of 



78 TypJuis and other Contimted Fevers. 

The epidemic fever of 1741-42. 

The harvest of 1739 had been an abundant one, and the 
export of grain had been large. At Lady-day the price of 
wheat had been 31^-. 6d. per quarter, and it rose \os. before 
Lady-day, 1740. An extremely severe winter had intervened, 
one of the three memorable winters of the i8th century. The 
autumn-sown wheat was destroyed by the prolonged and intense 
frost, and the price at Michaelmas, 1740, rose to 56^-. per quarter, 
the exportation being at the same time prohibited, but not 
until every available bushel had been sold to the foreigners. 
The long cold of the winter of 1739-40 had produced much 
distress and want in London, Norwich, Edinburgh and other 
towns. In London the mortality for 1740 rose to a very 
high figure, 30,811, of which 4003 deaths were from fever and 
2725 from smallpox. In mid-winter, 1739-40, coals rose to 
£'Xf. \os. per chaldron, owing to the navigation of the Thames 
being closed by ice ; the streets were impassable by snow, there 
was a " frost-fair" on the Thames, and in other respects a 
repetition of the events preceding the London typhus of 1685- 
86. The Gentleman s Magazine of January, 1740, tells in verse 
how the poor were " unable to sustain oppressive want and 
hunger's urgent pain," and reproaches the rich, — "colder their 
hearts than snow, and harder than the frost" ; while in its prose 
columns it announces that " the hearts of the rich have been 
opened in consideration of the hard fate of the poor\" The 
long, hard winter was followed by the dry spring and hot 
summer of 1740, during which the sickness (in Ireland at least) 
was of the dysenteric type. In the autumn of 1740 the epidemic 
is said to have taken origin both at Plymouth and Bristol from 
ships arriving with infection among the men — at the former 
port the king's ships ' Panther' and ' Canterbury,' at the 
latter a merchant ship. At Plymouth it was certainly raging 
enormously from June to the end of the year — " febris nautica 
pestilentialis jam saevit maxime," says Huxham ; it continued 

Ireland, "hardly excited any attention in England." It was severely felt, however, 
in England ; and if it excited hardly any attention, that must have been because 
there were so many superior interests which were more engrossing than the state of 
the poor. 

' Gcnl. Magaz. X. (1740), 32, 35. Blomefield, for Norwich, says that many there 
would have perished in the winter of 1739-40 but for help from their richer 
neighbours. 



Causes of the Epidemic TypJins of I'j^x. 79 

there all through the first half of 1741, "when it seemed to 
become lost in a fever of the bilious kind." It was in the 
dry spring and very hot summer of 1741 that the fever became 
general over England. Wall says that it appeared at Worcester 
at the Spring Assizes among a few ; at Exeter also it was traced 
to the gaol delivery ; and it was commonly said that the turmoil 
of the General Election (which resulted in driving Walpole from 
his long term of power) helped its diffusion. But undoubtedly 
the great occasion of its universality was a widely felt scarcity. 
The rise in the price of wheat was small beside the enormous 
leaps that prices used to take in the medieval period, having 
been at no time double the average low price of that generation. 
It was rather the want of employment that made the pinch 
so sharp in 1741. The weaving towns of the west of England 
were losing their trade ; of " most trades," also, it was said that 
they were in apparent decay, " except those which supply 
luxury\" Dr Barker, of Sarum, the best medical writer upon 
the epidemic, says : 

" The general poverty which has of late prevailed over a great part of 
this nation, and particularly amongst the woollen manufacturers in the west, 
where the fever has raged and still continues to rage with the greatest 
violence, affords but too great reason to believe that this has been one 
principal source of the disease^." 

He explains that the price of wheat had driven the poor 
to live on bad bread. This is borne out by a letter from 
Wolverhampton, 27 November, 1741^ The writer speaks of 
the extraordinary havoc made among the poorer sort by the 
terrible fever that has for some time raged in most parts of 
England and Ireland. At first it seldom fixed on any but 
the poor people, and especially such as lived in large towns, 
workhouses, or prisons. Country people and farmers seemed 
for the most part exempt from it, " though we have observed 
it frequently in villages near market towns" ; whereas, says the 
writer, the epidemic fevers of 1727, 1728 and 1729 were first 
observed to begin among the country people, and to be some 
time in advancing to large towns. This writer's theory was 
that the fever was caused by bad bread, and he alleges that 

^ W. Allen, Landholder^ s Companion, 1734. Cited by Tooke. 

"^ An Inquiry into the Nature, Catise and Cure of the present Epidemic Fever... 
with the difference betivixt Nei-zious and Inflammatory Fevers, and the Method of 
treating each, 1742, p. 54. 

^ John Altree, Gent, Magaz. Dec. 1741, p. 655. 



8o Typhus and other Continued Fevers. 

horse-beans, pease and coarse unsound barley were almost 
the only food of the poor. To this a Birmingham surgeon 
took exception \ Great numbers of the poor had, to his know- 
ledge, lived almost entirely upon bean-bread, but had been very 
little afflicted with the fever. Besides, every practitioner knew 
that the fever was not confined to the poor. He pointed out 
that in Wolverhampton, whence the bad-bread theory emanated, 
the proportion of poor to those in easier circumstances was as 
six to one, poverty having increased so much by decay of trade 
that many wanted even the necessaries of life. The Birmingham 
surgeon was on the whole inclined to the theory of " the 
ingenious Sydenham, that the disease may be ascribed to 
a contagious quality in the air, arising from some secret 
and hidden alterations in the bowels of the earth, passing 
through the whole atmosphere, or to some malign influence 
in the heavenly bodies" — these being Sydenham's words as 
applied to the fever of 1685-6. 

Barker, also, draws a parallel between the epidemic of 1741 
and that of 1685-86: the Thames was frozen in each of the 
two winters preceding the respective epidemics, and the spring 
and summer of 1740 and 1741 were as remarkable for drought 
and heat as those of 1684 and 1685. 

In London the deaths from fever in 1741 reached the 
enormous figure of 7528, the highest total in the bills of 
mortality from first to last, while the deaths from all causes 
were 32,119, in a population of some 700,000, also the highest 
total from the year of the great plague until the new registration 
of the whole metropolitan area in 1838. It will be seen from 
the following table (on p. 81) of the weekly mortalities that 
the fever-deaths rose greatly in the autumn, but, unlike the 
old plague, reached a maximum in the winter. 

The effects of the epidemic of typhus upon the weaving 
towns of the west of England, in which the fever lasted, as 
in London, into the spring of 1742, were seen at their worst 
in the instance of Tiverton. It was then a town of about 
8000 inhabitants, having increased little during the last hundred 
years. Judged by the burials and baptisms in the parish 
register it was a more unhealthy place since the extinction 
of plague than it had been before that. It was mostly a 
community of weavers, who had not been in prosperous circum- 

' While, i/iid. 1742, p. 43. 



The epidemic of 1741-42 in London. 



Mortality by Fever in London, 



1741 



Week 




All 


ending 


Fever 


causes 


/Tarch 10 


123 


660 


17 


103 


564 


24 


112 


624 


31 


105 


573 


April 7 


123 


670 


14 


128 


687 


21 


89 


580 


28 


123 


622 


May 5 


104 


495 


12 


141 


587 


19 


129 


573 


26 


153 


600 


June 2 


138 


512 


9 


138 


483 


16 


115 


536 


23 


127 


494 


30 


154 


513 


July 7 


149 


523 


14 


162 


551 


21 


130 


485 


28 


151 


621 


Aug. 4 


128 


512 


II 


142 


541 


18 


172 


636 


25 


192 


665 



1742 



1741-42. 






Week 




All 


ending 


Fever 


causes 


Sept. I 


171 


675 


8 


190 


691 


15 


182 


760 


22 


199 


748 


29 


189 


12>Z 


Oct. 6 


207 


784 


13 


192 


787 


20 


232 


793 


27 


234 


850 


Nov. 3 


250 


835 


10 


228 


772 


17 


182 


670 


24 


214 


806 


Dec. I 


224 


768 


8 


203 


748 


15 


191 


761 


22 


179 


775 


29 


180 


702 


Jan. 5 


221 


893 


12 


184 


760 


19 


184 


826 


26 


151 


724 


Feb. 2 


132 


675 


9 


103 


533 


16 


108 


675 


25 


103 


641 



Effects of the Epidemic of 1741-42 07i Provincial Towns. 
{Shorfs Abstracts of Parish Registers.) 



Year 
1740 
1 741 
1742 



Registers 
examined 

27 
27 
26 



With burials 
more than 
baptisms 

6 

14 
6 



Baptisms in 
the same 

1409 

3787 
1721 



Burials in 
the same 

1940 

6205 

3345 



stances for sometime past. In 1735 the town had been burned 
down, and in 1738 it was the scene of riots. The hard winter 
of 1739-40 brought acute distress, and in 1741 spotted fever 
was so prevalent that 636 persons were buried in that year, 
being i in 12 of the inhabitants. At the height of the epidemic 
ten or eleven funerals were seen at one time in St Peter's 
churchyard. Its population twenty years after is estimated 
to have declined by two thousand, and at the end of the 
1 8th century it was a less populous place than at the 
beginning\ 

1 Dunsford, Historical Memorials of Tiverton. The accounts of the great weaving 
towns of the South-west are not unpleasing until we come to the time when they 

c. II. 6 



82 Typhus and other Contimted Fevers. 

Other parts of the kingdom may be represented by Norwich, 
Newcastle and Edinburgh. The record of baptisms in Norwich 
is almost certainly defective; in only two years from 1719 to 

1 741, is a small excess of baptisms over burials recorded, 
namely, in 1722 and 1726, while in a third year, 1736, the 
figures are exactly equal. In 1740 there are 916 baptisms to 
1 173 burials, and in 1741, 851 baptisms to 1456 burials; while in 

1742, owing to an epidemic of smallpox, the deaths rose to 1953, 
or to more than double the recorded births \ The distress 
was felt most in East Anglia in 1740. Blomefield, who 
ends his history in that year, says there was much rioting 
throughout the kingdom, " on the pretence of the scarcity and 
dearness of grain." At Wisbech Assizes fourteen were found 
guilty, but were not all executed. In Norfolk two were 
convicted and executed accordingly. At Norwich the military 
fired upon the mob and killed seven persons, of whom only one 
was truly a rioter'^. It was also in the severe winter of 1739-40 
that the distress began in Edinburgh. The mills were stopped 
by ice and snow, causing a scarcity of meal ; the harvest of 
1740 was bad, riots took place in October, and granaries were 
plundered ^ The deaths from fever were many in 1740, but 
were nearly doubled in 1741, with a significant accompaniment 
of fatal dysentery* : 

Edinburgh Mortalities, 1740-41, 
(Population in 1732, estimated at 32,000.)'^ 





1740 


1741 


All causes 


1237 

278 


1611 


Consumption 


349 


Fever 


161 


304 


Flux 


3 


36 


Smallpox 


274 


206 


Measles 


100 


112 


Chincough 


26 


lOI 


Convulsions 


22 


16 



were overtaken by decay of work and distress, from about 1720 onwards. The 
district, says Defoe, was "a rich enclosed country, full of rivers and towns, and 
infinitely populous, in so much that some of the market towns are equal to cities in 
bigness, and superior to many of them in numbers of people." Taunton had iioo 
looms. Tiverton in the seven years 1700-1706 had 331 marriages, 1116 baptisms, 
1 1 75 burials (a slight excess), and an estimated population of 8693, whicli kept 
nearly at that level for about twenty years longer (from 1720 to 1726 the marriages 
were 284, the baptisms 1070 and the burials 1175). 

^ Gent. Magaz. XI. (1742), p. 704. 

^ Blomefield, History of NorfM, iii. 449. 

" Arnot, History of EdmlmrgJi, 1779, p. 211. 

"• Gent. Magaz. 1741, p. 705. •'' Edin. Aled. Essays and Obs, i. Art. i. 



I 



Symptoms of the Fever of ija^x. 83 

The last four items are of children's maladies, for which 
Edinburgh was worse reputed even than London. 

At Newcastle the deaths in the register in 1741 were 320 
more than in 1740, in which year they were doubtless excessive, 
as elsewhere. But there is a significant addition : " There have 
also been buried upwards of 400 upon the Ballast Hills near this 
town'." 

The symptoms of the epidemic fever of 1741-42 are described 
by Barker, of Salisbury, and Wall, of Worcester^ It began like 
a common cold, as was remarked also in Ireland. On the 
seventh day spots appeared like fleabites on the breast and 
arms ; in some there were broad purple spots like those of 
scurvy. Miliary eruptions were apt to come out about the 
eleventh day, especially in women. In most, after the first six 
or seven days, there was a wonderful propensity to diarrhoea, 
which might end in dysentery. The cough, which had appeared 
at the outset, went oft" about the ninth day, when stupor 
and delirium came on. Gilchrist, of Dumfries, describes the 
fever there in November, 1741, as more malignant than the 
"nervous fever" which he had described in 1735. It came to an 
end about the fourteenth day ; the sick were almost constantly 
under a coma or raving, and they died of an absolute oppression 
of the brain ; a profuse sweat about the seventh day was 
followed by an aggravation of all the symptoms^ An anony- 
mous writer, dating from Sherborne, uses the occasion to make 
an onslaught upon blood-letting"*. 

^ Gent. Magaz. 1742, p. 186. 

2 John Wall, M.D., Medical Tracts, Oxford, 1780, p. 337. See also Obs. on the 
Epid. Fever of I'l^i, 31-cl ed., by Daniel Cox, apothecary, with cases. 

^ Edin. Med. Essays and Obs. VI. 539. 

* " And here I cannot but observe how many ignorant conceited coxcombs ride 
out, under a shew of business, with their lancet in their pocket, and make diseases 
instead of curing them, drawing their weapon upon every occasion, right or wrong, 
and upon every complaint cry out, ' Egad ! I must have some of your blood,' give the 
poor wretches a disease they never might have had, drawing the blood and the purse, 
torment them in this world," etc. — An Essay on the present Epidemic Fever, Sher- 
borne, 1 741. The practice of blood-letting in continued fevers received a check in the 
second half of the i8th century, but it was still kept up in inflammatory diseases or 
injuries. Even in the latter it was freely satirized by the laity. When the surgeon in 
Tom Jones complained bitterly that the wounded hero would not be blooded though 
he was in a fever, the landlady of the inn answered : " It is an eating fever, then, for 
he hath devoured two swingeing buttered toasts this morning for breakfast." "Very 
likely," says the doctor, " I have known people eat in a fever; and it is very easily 
accounted for; because the acidity occasioned by the febrile matter may stimulate 
the nerves of the diaphragm, and thereby occasion a craving which will not be easily 
distinguishable from a natural appetite.... Indeed I think the gentleman in a very 
dangerous way, and, if he is not blooded, I am afraid will die." 



84 Typhus and other Continued Fevers. 

Sanitary Condition of London under George II. 

The great epidemic of fever in 1741-42 was the climax of a 
series of years in London all marked by high fever mortalities. 
If there had not been something peculiarly favourable to con- 
tagious fever in the then state of the capital, it is not likely that 
a temporary distress caused by a hard winter and a deficient 
harvest following should have had such effects. This was the 
time when the population is supposed to have stood still or even 
declined in London. Drunkenness was so prevalent that the 
College of Physicians on 19 January, 1726, made a repre- 
sentation on it to the House of Commons through Dr Freind, 
one of their fellows and member for Launceston : 

" We have with concern observed for some years past the fatal effects of 
the frequent use of several sorts of distilled spirituous liquor upon great 
numbers of both sexes, rendering them diseased, not fit for business, poor, a 
burthen to themselves and neighbours, and too often the cause of weak, 
feeble and distempered children, who must be, instead of an advantage and 
strength, a charge to their country ^" 

"This state of things," said the College, "doth every year 
increase." Fielding guessed that a hundred thousand in London 
lived upon drink alone ; six gallons per head of the population 
per annum is an estimate for this period, against one gallon at 
present. The enormous duty of 20s. per gallon served only to 
develope the trade in smuggled Hollands gin and Nantes brandy. 
In the harvest of 1733 farmers in several parts of Kent were 
obliged to offer higher wages, although the price of grain was 
low, and could hardly get hands on any terms, "which is 
attributed to the great numbers who employ themselves in 
smuggling along the coast I" 

The mean annual deaths were never higher in London, not 
even in plague times over a series of years, the fever deaths 
keeping pace with the mortality from all causes, and, in the 
great epidemic of typhus in 1741, making about a fourth part of 
the whole. The populace lived in a bad atmosphere, physical 
and moral. As Arbuthnot said in 1733, they "breathed their 
own steams " ; and he works out the following curious sum : 

"The perspiration of a man is about ^j^- of an inch in 24 hours, conse- 
quently one inch in 34 days. The surface of the skin of a middle-sized man 
is about 15 square feet ; consequently the surface of the skin of 2904 such 

^ Munk, Roll of the College of Pliysicians, 11. 53. 
- Geiitletnan's A/agaz. hi. 1733, Sept., p. 492. 



\ 
I 



The courts and alleys of Old London. 85 

men would cover an acre of ground, and the perspir'd matter would cover an 
acre of ground i inch deep in 34 days, which, rarefi'd into air, would make 
over that acre an atmosphere of the steams of their bodies near 71 foot 
high." This, he explains, would turn pestiferous unless carried away by the 
wind ; " from whence it may be inferred that the very first consideration in 
building of cities is to make them open, airy, and well perflated^" 

In the growth of London from a medieval walled city of 
some forty or sixty thousand inhabitants to the " great wen " of 
Cobbett's time, these considerations had been little attended to 
so far as concerned the quarters of the populace. The Liberties 
of the City and the out-parishes were covered with aggregates 
of houses all on the same plan, or rather want of plan. In the 
medieval period the extramural population built rude shelters 
against the town walls or in the fosse, if it were dry, or along the 
side of the ditch. The same process of squatting at length ex- 
tended farther afield, with more regular building along the sides of 
the great highways leading from the gates. Queen Elizabeth's 
proclamation of 1580 was designed to check the growth of 
London after this irregular fashion ; but as neither the original 
edict nor the numerous copies of it, reissued for near a hundred 
years, made any provision for an orderly expansion of the 
capital, these prohibitions had merely the effect of adding to 
the hugger-mugger of building, " in odd corners and over 
stables." The outparishes were covered with houses and tene- 
ments of all kinds, to which access was got by an endless maze of 
narrow passages or alleys ; regular streets were few in them, and 
it would appear from the account given by John Stow in 1598 of 
the parish of Whitechapel that even the old country highway, 
one of the great roads into Essex and the eastern counties, had 
been "pestered^" The "pestering" of the field lanes in the 
suburban parishes with poor cottages is Stow's frequent theme^ 

^ Effects of Air on Human Bodies, 1733, pp. ii, 17. His excellent remarks on 
the need of fresh air in the treatment of fevers, two generations before Lettsom 
carried out the practice, are at p. 54. The curious calculation above cited was copied 
by Langrish, and usually passes as his. 

^ " Also without the t)ars both sides of the street be pestered with cottages and 
alleys even up to Whitechapel Church, and almost half a mile beyond it, into the 
common field : all which ought to be open and free for all men. But this common 
field, I say, being sometime the beauty of this city on that part, is so encroached 
upon by building of filthy cottages, and with other purprestures, enclosures and 
laystalls (notwithstanding all proclamations and Acts of Parliament made to the 
contrary) that in some places it scarce remaineth a sufficient highway for the meeting 
of carriages and droves of cattle. Much less is there any fair, pleasant or wholesome 
way for people to walk on foot, which is no small blemish to so famous a city to have 
so unsavoury and unseemly an entrance or passage thereunto." Stow's Survey of 
London, section on "Suburbs without the Walls." 

* The line of an old field walk can still be followed from Aldermanbury Postern 
to Hackney, Goldsmiths' Row being one of the wider sections of it. 



86 TypJuts and other Continued Fevers. 

The borough of Southwark, as part of the City, may have been 
better than most : " Then from the Bridge straight towards the 
south a continual street called Long Southwark, built on both 
sides with divers lanes and alleys up to St George's Church, and 
beyond it through Blackman Street towards New Town or 
Newington " — the mazes of courts and alleys on either side of 
the Borough Road which may be traced in the maps long after 
Stow's time. So again in St Olave's parish along the river bank 
eastwards from London Bridge — "continual building on both 
sides, with lanes and alleys, up to Battle Bridge, to Horsedown, 
and towards Rotherhithe." In the Western Liberty, the lanes 
that had been laid out in Henry VIII.'s time, Shoe Lane, Fetter 
Lane and Chancery Lane, served as three main arteries to the 
densely populated area between Fleet Street and Holborn, but 
for the rest it was reached by a plexus or rete mirabile of alleys 
and courts, notorious even in the 19th century. In like manner 
Drury Lane and St Martin's Lane were the main arteries 
between High Holborn and the Strand. One piazza of Covent 
Garden was a new centre of regular streets, to which the haber- 
dashers and other trades were beginning to remove from the 
City, for greater room, about 1662. The Seven Dials were a 
wonder when they were new, about 1694, and had the same 
intention of openness and regularity as in Wren's unused design 
for the City after the fire. The great speculative builder of the 
Restoration was Nicholas Barbone, son of Praise-God Barbones, 
He built over Red Lion Fields, much to the annoyance of the 
gentlemen of Gray's Inn\ and his manner of building may be 
inferred from the following : 

" He was the inventor of this new method of building by casting of 
ground into streets and small houses, and to augment their number with as 
little front as possible, and selling the ground to workmen by so much per 
foot front, and what he could not sell build himself. This has made ground- 
rents high for the sake of mortgaging ; and others, following his steps, 
have refined and improved upon it, and made a superfoetation of houses 
about London^." 

In these mazes of alleys, courts, or " rents " the people were 
for the most part closely packed. Overcrowding had been the 
rule since the Elizabethan proclamation of 1580, and it seems to 
have become worse under the Stuarts. On February 24, 1623, 

1 Luttrell's Diary lo June, 1684. 

"^ Roger North's " Autol;iography," in Lives of the Norths, new eel. 3 vols., 1890, 
ni. 54. 



Nuisances indoors and out of doors. 87 

certain householders of Chancery Lane were indicted at the 
Middlesex Sessions for subletting, " to the great danger of in- 
fectious disease, with plague and other diseases." In May, 1637, 
one house was found to contain eleven married couples and 
fifteen single persons ; another house harboured eighteen lodgers. 
In the most crowded parishes the houses had no sufficient 
curtilage, standing as they did in alleys and courts. When we 
begin to have some sanitary information long after, it appears 
that their vaults, or privies, were indoors, at the foot of the 
common stair'. In 17 10, Swift's lodging in Bury Street, St 
James's, for which he paid eight shillings a week (" plaguy 
deep " he thought), had a " thousand stinks in it," so that he 
left it after three months. The House of Commons appears to 
have been ill reputed for smells, which were specially remembered 
in connexion with the hot summer of the great fever-year 1685 ^ 
The newer parts of London were built over cesspools, 
which were probably more dangerous than the visible nuisances 
of the streets satirized by Swift and Gay. There were also 
the "intramural" graveyards; of one of these, the Green Ground, 
Portugal Street, it was said by Walker, as late as 1839; "The 
effluvia from this ground are so offensive that persons living 
in the back of Clement's Lane are compelled to keep their 
windows closed." But that which helped most of all to make 
a foul atmosphere in the houses of the working class, an 
atmosphere in which the contagion of fever could thrive, was 
the window-tax. It is hardly possible that those who devised 
it can have foreseen how detrimental it would be to the public 
health ; it took nearly a century to realize the simple truth that 
it was in effect a tax upon light and air. 

^ Willan, 1801 : " The passage filled with putrid excremental or other abominable 
effluvia from a vault at the bottom of the staircase." See also Clutterbuck, Epid. 
Fever at present prevailing. Lond. 1819, p. 60. Ferriar, of Manchester, writing of 
the class of houses most apt to harbour the contagion of typhus, says, " Of the new 
buildings I have found those most apt to nurse it which are added in a slight manner 
to the back part of a row, and exposed to the effluvia of the privies." 

^ C. Davenant to T. Coke, London, 14 Dec. 1700. Cal. Coke MSS., II. 411, "I 
heartily commiserate your sad condition to be in the country these bad weeks ; but I 
fancy you will find Derbyshire more pleasant even in winter than the House of 
Commons will be in a summer season. For, though it be now sixteen years ago 
[1685], I still bear in memory the evil smells descending from the small apartments 
adjoining to the Speaker's Chamber, which came down into the House with irresistible 
force when the weather is hot." 



88 Typhus and other Continued Fevers. 

The Window-Tax. 

Willan, writing of fever in London in 1799, mentions that 
even the passages of tenement houses were " kept dark in order 
to lessen the window-tax," and the air therefore kept foul\ 
Ferriar, writing of Manchester in the last years of the 18th 
century, mentions, among other fever-dens, a large house in an 
airy situation which had been built for a poor's-house, but 
abandoned : having been let to poor families for a very trifling 
rent, many of the windows and the principal entrance were 
built up, and the fever then became universal in it^ The 
Carlisle typhus described by Heysham for 1781 began in a 
house near one of the gates, tenanted by five or six very poor 
families; they had "blocked up every window to lessen the 
burden of the window-taxi" John Howard's interest having 
been excited in the question of gaol-fever, he noted the effects 
of the window-tax not only in prisons but in other houses. The 
magistrates of Kent appear to have paid the tax for the gaols 
in that county from the county funds ; but in most cases the 
burden fell on the keepers of the gaols. 

"The gaolers," says Howard, "have to pay it ; this tempts them to stop 
the windows and stifle their prisoners ;" and he appends the following note : 
" This is also the case in many work-houses and farm-houses, where the 
poor and the labourers are lodged in rooms that have no light nor fresh 
air ; which may be a cause of our peasants not having the healthy ruddy 
complexions one used to see so common twenty or thirty years ago. The 
difference has often struck me in my various journeys*." 

Such impressions are known to be often fallacious ; but in 
the history of the window-tax, which we shall now follow, it will 
appear that there was a new law, with increased stringency, in 
the years 1746-1748, corresponding to the "twenty or thirty 
years ago " of Howard's recollection. 

The window-tax was originally a device of the statesmen 
of the Revolution "for making good the deficiency of the clipped 
money." By the Act of 7 and 8 William and Mary, cap. 18, 
taking effect from the 25th March, 1696, every inhabited house 
owed duty of two shillings per annum, and, over and above such 
duty on all inhabited houses, every dwelling-house with ten 
windows owed four shillings per annum, and every house with 

' Report oil the Diseases in London, 1796-1800. Load. 1801. 

- John Ferriar, M.D., Medical Histories and Reflections. London 1810,11. 217. 

■' Heysham, Jail Fever at Carlisle in 1781. Lond. 1782, p. },},. 

' John Howard, State of the Prisons. 



The Window-tax. 89 

twenty windows eight shillings. In 17 10 houses with from twenty 
to thirty windows were made to pay ten shillings, and those with 
more than thirty windows twenty shillings. Various devices 
were resorted to to check the evasions of bachelors, widows 
and others. A farmer had to pay for his servants, recouping 
himself from their wages. A house subdivided into tenements 
was to count as one ; which would have made the tax difficult 
to gather except from the landlord. The machinery of collec- 
tion was a board of commissioners, receivers-general and col- 
lectors. 

But in the 20th of George II. (1746) the basis of the law 
was changed. The tax was levied upon the several windows 
of a house, so much per window, so that it fell more decisively 
than before upon the tenants of tenement-houses, and not on 
the landlords. The two-shillings house duty was continued ; 
but the window-tax became sixpence per annjjm for every 
window of a house with ten, eleven, twelve, thirteen or fourteen 
windows, or lights, ninepence for every window of a house with 
fifteen, sixteen, seventeen, eighteen or nineteen windows, and 
one shilling for every window of a house with twenty or more 
windows. An exemption in the Act in favour of those re- 
ceiving parochial relief was decided by the law officers of the 
Crown not to apply to houses with ten or more windows or 
lights, which would have included most tenement-houses ; on 
the other hand they ruled that hospitals, poor-houses, workhouses, 
and infirmaries were not chargeable with the window duty. To 
remove doubts and check evasions another Act was made in 
21 George II. cap. 10. All skylights, and lights of staircases, 
garrets, cellars and passages were to count for the purpose of 
the tax ; also certain outhouses, but not others, were to count 
as part of the main dwelling whether they were contiguous or 
not. The i ith paragraph of the Amendment Act shows how 
the law had been working in the course of its first year : " No 
window or light shall be deemed to be stopped up unless such 
window or light shall be stopped up effectually with stone or 
brick or plaister upon lath," etc. 

This remained the law down to 1803, when a change was 
made back to the original basis of rating houses as a whole, 
according to the number of their windows, the rate being 
considerably raised and fixed according to a schedule. The 
tax for tenement houses was at the same time made recoverable 



90 Typhus and other Continued Fevers. 

from the landlord. The window-tax thus became a form of 
the modern house-tax, rated upon windows instead of upon 
rental, and so lost a great part of its obnoxious character. 

The law of 1747-48, which taxed each window separately, 
and was enforced by a galling and corrupt machinery of com- 
missioners, receivers-general and collectors paid by results, could 
not fail to work injuriously ; for light aud air, two of the 
primary necessaries of life, were in effect taxed. Even rich 
men appear to have taken pleasure in circumventing the col- 
lectors\ But it was among the poor, and especially the in- 
habitants of tenement houses, that the effect was truly disastrous; 
a tax on the skylights of garrets and on the lights of cellars, 
staircases and passages, taught the people to dispense with them 
altogether. Towards the end of the i8th century the grievance 
became now and then the subject of a pamphlet or a sermon. 

« 

Gaol-Fever. 

Besides these ordinary things favouring contagious epi- 
demic fever both in town and country, there were two special 
sources of contagion, the gaols and the fleets and armies. I 
shall take first the state of the gaols, which has been already 
indicated in speaking of the window-tax. In the opinion of 
Lind, a great part of the fever, which was a constant trouble 
in ships of the navy, came direct from the gaols through the 
pressing of newly discharged convicts. 

The state of the prisons in the first half of the 18th century 
was certainly not better than Howard found it to be a generation 
after ; it was probably worse, for the administration of justice 
was more savage. About the beginning of the century, many ' 
petitions were made to Parliament by imprisoned debtors, com- 
plaining of their treatment, and a Bill was introduced in 1702. 
Sixty thousand were said to be in prison for debt''. On 25 

1 Notes and Queries, 4th ser. xii. 346. Jenkinson, who was a Minister under 
George II., was reputed to have set an example of stopping up windows in his 
mansion near Croydon : 

You e'en siiut out the Hght of day 

To save a paltry shilling. 

Others had boards painted to look like brickwork, which could be used to cover up 
windows at pleasure. 

- Petition, undated, but placed in a collection in the British Museum_ among 
broadsides of the years 1696-1700. In 1725 the imprisoned debtors at Liverpool 
petitioned Parliament for relief, alleging that they were reduced to a starving condi- 



Oglethorpe's Committee on Gaols, 1729. 9I 

February, 1729, the House of Commons appointed a committee 
" to inquire into the state of the gaols of this Kingdom " ; but 
only two prisons were reported on, the Fleet and the Marshalsea, 
in London, the inquiries upon these being due to the energy 
of Oglethorpe, then at the beginning of his useful career. The 
committee found a disgraceful state of things : — wardens, tip- 
staffs and turnkeys making their offices so lucrative by extortion 
that the reversion of them was worth large sums, prisoners 
abused or neglected if they could not pay, some prisoners kept 
for years after their term was expired, the penniless crowded 
three in a bed, or forty in one small room, while some rooms 
stood empty to await the arrival of a prisoner with a well-filled 
purse. On the common side of the Fleet Prison, ninety-three 
prisoners were confined in three wards, having to find their own 
bedding, or pay a shilling a week, or else sleep on the floor. 
The " Lyons Den " and women's ward, which contained about 
eighteen, were very noisome and in very ill repair. Those who 
were well had to lie on the floor beside the sick. A Portuguese 
debtor had been kept two months in a damp stinking dungeon 
over the common sewer and adjoining to the sink and dunghill ; 
he was taken elsewhere on payment of five guineas. In the 
Marshalsea there were 330 prisoners on the common side, 
crowded in small rooms. George's ward, sixteen feet by fourteen 
and about eight feet high, had never less than thirty-two in it " all 
last year," and sometimes forty ; there was no room for them 
all to lie down, about one-half of the number sleeping over the 
others in hammocks ; they were locked in from 9 p.m. to 5 a.m. 
in summer (longer hours in winter), and as they were forced 
to ease nature within the room, the stench was noisome beyond 
expression, and it seemed surprising that it had not caused a 
contagion ; several in the heat of summer perished for want of 
air. Meanwhile the room above was let to a tailor to work in, 
and no one allowed to He in it. Unless the prisoners were 
relieved by their friends, they perished by famine. There was 
an allowance of pease from a casual donor who concealed his 
name, and 30 lbs. of beef three times a week from another 
charitable source. The starving person falls into a kind of 
hectic, lingers for a month or two and then dies, the right of 
his corpse to a coroner's inquest being often scandalously re- 

tion, having only straw and water at the courtesy of the Serjeant. Commons' 
yournals, xx. 375. 



92 TypJms and other Continued Fevers. 

fused \ The prison scenes in Fielding's Amelia are obviously 
faithful and correct. 

Oglethorpe's committee had done some good since they first 
met at the Marshalsea on 25th March, 1729, not above nine 
having died from that date to the 14th May ; whereas before 
that a day seldom passed without a death, " and upon the 
advancing of the spring not less than eight or ten usually died 
every twenty-four hours." Two of the chief personages concerned 
were found by a unanimous vote of the House of Commons 
to have committed high crimes and misdemeanours ; but when 
they were tried before a jury on a charge of felony they were 
found not guilty. 

About a year after these reports to the Commons there was 
a tragic occurrence among the Judges and the Bar of the 
Western Circuit during the Lent Assizes of 1730. The 
Bridewell at Taunton was. filled for the occasion of the Assizes 
with drafts of prisoners from other gaols in Somerset, among 
whom several from Ilchester were said to have been more than 
ordinarily noisome. Over a hundred prisoners were tried, of 
whom eight were sentenced to death (six executed), and seven- 
teen to transportation. As the Assize Court continued its circuit 
through Devon and Dorset several of its members sickened of 
the gaol fever and died: Piggot, the high-sheriff, on the nth 
April, Sir James Sheppard, serjeant-at-law, on 13th April at 
Honiton, the crier of the court and two of the Judge's servants 
at Exeter, the Judge himself, chief baron Pengelly, at Bland- 
ford, and serjeant-at-law Rous, on his return to London, whither 
he had posted from Exeter as soon as he felt ill ^ It is said 
that the infection afterwards spread within the town of Taunton, 
where it arose, " and carried off some hundreds " ; but the local 
histories make no mention of such an epidemic in 1730, and 
no authority is cited for it I Something of the same kind is 

1 Commons' Journals, 20 March, lyff, 14 May, 1729, 24 March, lyH- 

"Mrs Mary Trapps was prisoner in the Marshalsea and was put to lie in the same 
bed with two other women, each of which paid 2s. 6d. perjweek chamber rent; she 
fell ill and languished for a considerable time ; and the last three weeks grew so 
offensive that the others were hardly able to bear the room ; they frequently com- 
]Dlained to the turnkeys and officers, and desired to be removed ; but all in vain. At 
last she smelt so strong that the turnkey himself could not bear to come into the 
room to hear the complaints of her bedfellows ; and they were forced to lie with her 
on the boards, till she died." 

" Political State of Great Brilain, xxxix. April, 17.50, pp. 4.50-4.^1, 448. 

'' Gent. Magaz., XX. 235. This authority is twenty years after the event, the 
incident having been recalled in 1750, on the occasion of the Old Bailey catastrophe. 



The Old Bailey Black Assizes, 1750. 93 

believed to have happened at a gaol delivery at Launceston in 
1742, but the circumstances are vaguely related, and it does not 
appear that any prominent personage in the Assize Court died 
on the occasion \ 

The great instance of a Black Assize in the i8th century, 
comparable to those of Cambridge, Oxford and Exeter in the 
i6th^ was that of the Old Bailey Sessions in London in April, 
1750. It has been fully related by Sir Michael Foster, one of 
the justices of the King's Bench, who had himself been on the 
bench at the January sessions preceding, and was the intimate 
friend of Sir Thomas Abney, the presiding judge who lost his 
life from the contagion of the April sessions^. 

"At the Old Bailey sessions in April, 1750, one Mr Clarke was brought 
to his trial ; and it being a case of great expectation, the court and all the 
passages to it were extremely crowded ; the weather too was hotter than is 
usual at that time of the year*. Many people who were in court at this 
time were sensibly affected with a very noisome smell ; and it appeared 
soon afterwards, upon an enquiry ordered by the court of aldermen, that the 
whole prison of Newgate and all the passages leading thence into the court 
were in a very filthy condition, and had long been so. What made these 
circumstances to be at all attended to was, that within a week or ten days at 
most, after the session, many people who were present at Mr Clarke's trial 
were seized with a fever of the malignant kind ; and few who were seized 
recovered. The symptoms were much ahke in all the patients, and in less 
than six weeks time the distemper entirely ceased. It was remarked by 
some, and I mention it because the same remark hath formerly been made 
on a like occasion [Oxford, 1577], that women were very little affected : 
I did not hear of more than one woman who took the fever in court, though 
doubtless many women were there. 

"It ought to be remembered that at the time this disaster happened there 
was no sickness in the gaol more than is common in such places. This 
circumstance, which distinguisheth this from most of the cases of the like 
kind which we have heard of, suggesteth a very proper caution : not to 
presume too far upon the health of the gaol, barely because the gaol-fever is 
not among the prisoners. For without doubt, if the points of cleanliness 
and free air have been greatly neglected, the putrid effluvia which the 
prisoners bring with them in their clothes etc., especially where too many 
are brought into a crowded court together, may have fatal effects on people 
who are accustomed to breathe better air ; though the poor wretches, who 
are in some measure habituated to the fumes of a prison, may not always be 
sensible of any great inconvenience from them. 

"The persons of chief note who were in court at this time and died of the 
fever were Sir Samuel Pennant, lord mayor for that year. Sir Thomas 
Abney, one of the justices of the Common Pleas, Charles Clarke, esquire, 

^ Huxham. 

^ See the former volume of this History, pp. 375-386. 

•* A Report ^'c. and of other Crown Cases. By Sir Michael Foster, Knt., some 
time one of the Judges of the Court of King's Bench. 2nd ed. London, 1776, p. 74. 

* The Gentleman'' s Magazine however says (1750, p. 235): "There being a very 
cold and piercing east wind to attack the sweating persons when they came out of 
court." 



94 TypJius a?id other Conthmed Fevers. 

one of the barons of the exchequer, and Sir Daniel Lambert, one of the 
aldermen of London. Of less note, a gentleman of the bar, two or three 
students, one of the under-sheriffs, an officer of Lord Chief Justice Lee, who 
attended his lordship in court at that time, several of the jury on the 
Middlesex side, and about forty other persons whom business or curiosity 
had brought thither," 

The same thing was remarked here as at Exeter in 1586 
that those who sat on the side of the Court nearest to the dock 
were most attacked by the infection \ When the cases of fever 
began to occur, after the usual incubation of " a week or ten 
days," there was much fear of the infection spreading, so that 
many famihes, it is said, retired into the country^. But Pringle 
wrote on 24 May, " However fatal it has been since the Sessions, 
it is highly probable that the calamity will be in a great 
measure confined to those who were present at the tryaP;" and 
Justice Foster gives no hint of anyone having taken the fever 
who was not present in court. 

The tragedy of gaol-fever at the Old Bailey in 1750 secured 
increased attention to the subject of scientific ventilation. The 
great bar to fresh air indoors throughout the i8th century was 
the window-tax. It bore particularly hard on prisoners, for the 
gaolers had to pay the window-tax out of their profits, and 
they naturally preferred to build up the windows. Scientific 
ventilation of gaols was something of a mockery in these 
circumstances ; but it is the business of science to find out 
cunning contrivances, and ingenious ventilators were devised for 
Newgate, the leading spirit in this work being the Rev. Dr Hales, 
rector of a parish near London, and an amateur in physiology at 
the meetings of the Royal Society. 

A ventilating apparatus had been erected at Newgate about 
a year before the fatal sessions of 1650, but it does not seem to 
have answered. It consisted of tubes from the various wards 
meeting in a great trunk which opened on the roof A com- 
mittee of the Court of Aldermen in October 1750 resolved, 
after consulting Pringle and Hales, to add a windmill on the 
leads over the vent, and that was done about two years after. 
Pringle, who inspected the ventilator on 11 July, 1752, says that 

^ See Bancroft, Essay on the Yellrw Fever, with observations concerning febi-ile 
contagion etc. Lend. 1811. 

^ Gent. Magaz. 1750, p. 274: "Many families are retired into the country, and 
near 12,000 houses empty" — an impossible number. 

•* Sir John Pringle, Observations on the Nature and Cure of the Hospital and yayl 
Fii'cr. Letter to Mead, May 24. London, 1750. 



Hoivard's discoveries of Gaol- fever. 95 

a considerable stream of air of a most offensive smell issued 
from the vent ; and it appeared that no fewer than seven of the 
eleven carpenters who were working at the alterations on the 
old ventilator caught gaol-fever (of the petechial kind), which 
spread among the famihes of some of them*. Pringle and Hales 
were of opinion that the wards furnished with tubes were less 
foul than the others ; and they claimed, on the evidence of 
the man who took care of the apparatus, that only one person 
had died in the gaol in two months, whereas, before the 
windmill was used, there died six or sev6n in a week^ But 
Oglethorpe had claimed an improvement of the same kind 
at the Marshalsea in 1729 merely from having the prisoners 
saved from hunger ; and Lind, who was a most matter-of-fact 
person, did not think that the ingenious contrivances for venti- 
lation had answered their end^ 

Howard's visitations of the prisons, which began in 1773 
and were continued or repeated during several years following, 
brought to light many instances of epidemic sickness therein, 
which was nearly always of the nature of gaol-typhus. The 
following is a list compiled from his various reports, the two or 
three instances of smallpox infection being given elsewhere. 

Wood Street Compter, London. About 100 in it, chiefly debtors. Eleven 

died in beginning of 1773; since then it has been visited by Dr Lettsom 

at the request of the aldermen. 
Savoy, London. On 15 March, 1776, 119 prisoners. Many sick and dying. 

Between that date and next visit, 25 May, 1776, the gaol-fever has been 

caught by many. 
Hertford. Inmates range from 20 to 30. In the interval of two visits, the 

gaol-fever prevailed and carried off seven or eight prisoners and two 

turnkeys. (The interval probably corresponded to the admission of an 

unusual number of debtors.) 
Chelmsford. Number of inmates varies from 20 to 60, about one-half debtors. 

A close prison frequently infected with the gaol-distemper. 
Dartford, County Bridewell. A small prison. About two years before 

visit of 1774 there was a bad fever, which affected the keeper and his 

family and every fresh prisoner. Two died of it. 
Horsham, Bridewell. The keeper a widow : her husband dead of the 

gaol-fever. 

^ One of the cases was that of an apprentice : " Some of the journeymen working 
in Newgate had forced him to go down into the great trunk of the ventilator in order 
to bring up a wig which one of them had thrown into it. As the machine was then 
working, he had been almost suffocated with the stench before they could get him up." 
Pringle, "Ventilation of Newgate," Phil. Trans. 1753, p. 4-2. 

^ Thomas Stibbs to Sir John Pi-ingle, Jan. 25, 1753. Ibid. p. 5^. 

^ " Ventilators some years since when first introduced, it was thought, would prove 
an effectual remedy for and preservative against this infection in jails ; great ex- 
pectations were formed of their benefit, but several years' experience must now have 
fully shewn that ventilators will not remove infection from a jail." Lind, Means of 
Preserving the Health of Seamen in the Royal Navy. New ed. Lond. 1774, p. 29. 



96 Typhus and other Continued Fevers. 

Petworth, Bridewell. Allowance per diem a penny loaf (7J oz.). Th. 
Draper and Win. Godfrey committed 6 Jan., 1776 : the former died on 
II Jan., the other on i6th. Wm. Cox, committed 13 Jan., died 23rd. 
" None of these had the gaol-fever. I do not affirm that these men 
were famished to death ; it was extreme cold weather." After this the 
allowance of bread was doubled, thanks to the Duke of Richmond. 

Sotethwark, the new gaol. Holds up to 90 debtors and felons. " In so 
close a prison I did not wonder to see, in March, 1776, several felons 
sick on the floors." No bedding, nor straw. The Act for preserving 
the health of prisoners is on a painted board. 

Aylesbury. About 20 prisoners. First visit Nov., 1773, second Nov., 1774: 
in the interval six or seven died of the gaol-distemper. 

Bedford. About twenty years ago the gaol-fever was in this prison ; some 
died there, and many in the town, among whom was Mr Daniel, the 
surgeon who attended the prisoners. The new surgeon changed the 
medicines from sudorifics to bark and cordials ; and a sail-ventilator 
being put up the gaol has been free from the fever almost ever since. 
(This was the gaol which is often said to have started Howard on his 
inquiries when he was High Sheriff) 

Warwick. Holds up to fifty-seven. The late gaoler died in 1772 of the 
gaol-distemper, and so did some of his prisoners. No water then ; 
plenty now. 

Southwell, Bridewell. A small prison. A few years ago seven died here of 
the gaol-fever within two years. 

Worcester. Has a ventilator. Mr Hallward the surgeon caught the gaol- 
fever some years ago, and has ever since been fearful of going into the 
dungeon ; when any felon is sick, he orders him to be brought out. 

Shrewsbury. Gaol-fever has prevailed here more than once of late years. 

Monmouth. At first visit in 1774, they had the gaol-fever, of which died the 
gaoler, several of his prisoners, and some of their friends. 

Usk {Monmouth) Bridewell. The keeper's wife said that many years ago 
the prison was crowded, and that herself, her father who was then 
keeper, and many others of the family had the gaol-fever, three of whom, 
and several of the prisoners, died of it. 

Gloucester., the Castle. Many prisoners died here in 1773 ; and always 
except at Howard's last visit, he saw some sick in this gaol. A large 
dunghill near the stone steps. The prisoners miserable objects : Mr 
Raikes and others took pity on them. 

Winchester. The former destructive dungeon was down eleven steps, and 
darker than the present. Mr Lipscomb said that more than twenty 
prisoners had died in it of the gaol-fever in one year, and that the 
surgeon before him had died of it. 

Liverpool. Holds about sixty, offensive, crowded. Howard in March, 1774, 
told the keeper his prisoners were in danger of the gaol-fever. Between 
that date and Nov., 1775, twenty-eight had been ill of it at one time. 

Chester, the Castle. Dungeon used to imprison military deserters. Two 
of them brought by a sergeant and two men to Worcester, of which 
party three died a few days after they came to their quarters. (For fever 
in this prison in 17 16 see the text, p. 60.) 

Cowbridge. The keeper said, on 19 August, 1774, that many had died of 
the gaol-fever, among them a man and a woman a year before, at which 
time himself and daughter were ill of it. 

Cambridge, the Town Bridewell. In the spring of 1779, seventeen women 
were confined in the daytime, and some of them at night, in the 
workroom, which has no fireplace or sewer. This made it extremely 
offensive, and occasioned a fever or sickness among them, which so 
alarmed the Vice- Chancellor that he ordered all of them to be discharged. 
Two or three of them died within a few days. 



Hoivard's and Lettsom's instances of Gaol-fever. 97 

Exeter, the County Bridewell. Between first visit in 1775 and next on 
5 Feb., 1779, the surgeon and two or three prisoners have died of the 
gaol-fever. In 1755 3- prisoner discharged from the gaol went home to 
Axminster, and infected his family, of whom two died, and many others 
in that town afterwards. 

Exeter, the High Gaol for felons. Mr Bull, the surgeon, stated that he was 
by contract excused from attending in the dungeons any prisoners that 
should have the gaol-fever. 

Wi7ichester, Bridewell. Close and small. Receives many prisoners from 
other gaols at Quarter Sessions. It has been fatal to vast numbers. 
The misery of the prisoners induced the Duke of Chandos to send them 
for some years 30 lbs. of beef and 2 gallon loaves a week. 

Devises, Bridewell. Two or three years ago the gaol-fever carried off many. 
An infirmary added since then. 

Marlborough. The rooms offensive. Saw one dying on the floor of the 
gaol-fever. One had died just before, and another soon after his 
discharge. 

Lattnceston. Small, with offensive dungeons. No windows, chimneys, or 
drains. No water. Damp earthen floor. Those who serve there 
often catch the gaol-fever. At first visit, found the keeper, his assistant 
and all the prisoners but one sick of it (on 19 Feb., 1774, eleven felons 
in it). Heard that, a few years before, many prisoners had died of 
it, and the keeper and his wife in one night. A woman confined three 
years by the Ecclesiastical Court had three children born in the gaol. 

Bodjnin, Bridewell. Much out of repair. The night rooms are two garrets 
with small close-glazed skylight 17 in. x 12 in. A few years ago 
the gaol-fever was very fatal, not only in the prison but also in the 
town. 

Tau7iton, Bridewell. Six years ago, when there was no infirmary provided, 
the gaol-fever spread over the whole prison, so that eight died out of 
nineteen prisoners. 

Shepton Mallet. Men's night room close, with small window. So unhealthy 
some years ago that the keeper buried three or four in a week. 

Thirsk. Prisoners had the gaol-fever not long ago. 

Carlisle. During the gaol-fever which some years ago carried off many of 
the prisoners, Mr Farish, the chaplain, visited the sick every day. 

I shall add some medical experiences of gaol-fever in 

London from the notes of Lettsom^: — 

May, 1773. A person released from Newgate "in a malignant or jail- 
fever" was brought into a house in a court off Long Lane, Aldersgate 
Street ; soon after which fourteen persons in the same confined court were 
attacked with a similar fever: one died before Lettsom was called in, 
one was sent to hospital, eleven attended by him all recovered, though with 
difficulty. Two deaths in Wood Street Compter : i. Rowell, an industrious, 
sober workman, who had supported for many years a wife and three 
children; some of these having been lately sick, he fell behind with his 
rent, a little over three guineas ; he offered all he had (more than enough) 
to the landlord, but the latter preferred to throw the man and his family 
into the Compter, where Rowell died of fever. 2. Russell, once a reputable 
tradesman on Ludgate Hill, fell into a debt of under three guineas, sent 
to the Compter with his wife and five children, took fever and died; 
attended in his sickness in a bare room by his eldest daughter, elegant and 
refined, aged seventeen ; his son, aged fourteen, took the fever and re- 
covered. 

^ J. C. Lettsom, M.D., Medical Memoirs of the General Dispensary in London, 
1773-4- Lend. 1774. 

C. II. ^ 7 



98 Typhus a)id other Contimicd Fevers. 

There was one Black Assize at this period, at Dublin in 
April 1776. A criminal, brought into the Court of Sessions 
without cleansing, infected the court and alarmed the whole 
city. Among others who died of the contagion were Fielding 
Ould, High Sheriff, the counsellors Derby, Palmer, Spring and 
Ridge, Mr Caldwell, Messrs Bolton and Eriven, and several 
attorneys and others whose business it was to attend the court \ 

There were two notorious outbreaks of malignant fever 
among foreign prisoners of war, one in 1761''' and another in 
1780^, the first among BVench and Spaniards at Winchester and 
Portchester, the second among Spaniards at Winchester. 

Howard found so little typhus in the gaols in his later visits 
that it seemed as if banished for good. But it was heard of 
frequently about 1780-85 — at Maidstone, at Aylesbury, at Wor- 
cester, costing the lives of some of the visiting physicians. 

Circumstances of severe and mild Typhus. 

The circumstances of the gaol distemper bring out one 
grand character of typhus which will have to be stated formally 
before we go farther. Ordinary domestic typhus was not a very 
fatal disease. Haygarth says that of 285 attacked by it in the 
poorer quarters of Chester in the autumn of 1774, only twenty- 
eight died. Ferriar, in Manchester, had sometimes an even 
more favourable experience than that : " The mortality of the 
epidemic was not great,... out of the first ninety patients whom 
I attended, only two died." This was before the House of 
Recovery was opened ; so that the low mortality was of typhus 
in the homes of the people. 

The fever was often an insidious languishing, without great 
heat, and marked most by tossing and wakefulness, which might 
pass into delirium ; when it went through the members of a 
family or the inmates of a house, there would be some cases 
concerning which it was hard to say whether they were cases of 
typhus or not. Misery and starvation brought it on, and often 
it was itself but a degree of misery and starvation. " I have 
found," says Ferriar, ''that for three or four days before the 

^ Gent. Magaz. 1776, April 11. p. 187. 

^ Lind, Two Papers oil Fevers and Infection. Lond. 17(13- pp.90, 106. Many 
cases had buljoes both in the groins and the armpits. 

•' Carmicliael Smyth, Description of the Jail Distemper among Spanish Prisoners 
at IVinchester'm 17S0. Lond. 1795. 



Ciramista7ices of the most fatal TypJms. 99 

appearance of typhus in a family consisting of several children, 
they had subsisted on little more than cold water." " It has been 
observed," says Langrish, " that those who have died of hunger 
and thirst, as at sieges and at sea, etc., have always died 
delirious and feverish." The fever was on the whole a distinct 
episode, but in many cases it had no marked crisis. "Those 
women who recovered," says Ferriar, "were commonly affected 
with hysterical symptoms after the fever disappeared ; " and 
again : "Fevers often terminate in hysterical disorders, especially 
in women ; men, too, are sometimes hysterically inclined upon 
recovering from typhus, for they experience a capricious dis- 
position to laugh or cry, and a degree of the globus hystericus." 
These were probably the more case-hardened people, inured to 
their circumstances, their healthy appetite dulled by the prac- 
tice of fasting or " clemming," or by opium, and their blood 
accustomed to be renovated by foul air. If the limit of 
subsistence be approached gradually, life may be sustained 
thereat without any sharp crisis of fever, or with only such an 
interlude of fever as differs but little from a habit of body 
unnamed in the nosology. 

The worst kind of typhus, often attended with delirium, 
crying and raving, intolerable pains in the head, and livid spots 
on the skin, ending fatally perhaps in two or three days, or after 
a longer respite of stupor or waking insensibility, was commonly 
the typhus of those not accustomed to the minimum of wellbeing 
— the typhus of hardy felons newly thrown into gaol, of soldiers 
in a campaign crowded into a hospital after a season in the 
open air, of sailors on board ship mixing with newly pressed 
men having the prison atmosphere clinging to them, of judges, 
counsel, officials of the court and gentlemen of the grand jury 
brought into the same atmosphere with prisoners at a gaol- 
delivery, of the wife and children of a discharged prisoner 
returned to his home, of the gaol-keeper, gaol-chaplain, or 
gaol-doctor, of the religious and charitable who visited in poor 
localities even where no fever was known to be, and most of all 
of country people who crowded to the towns in search of work 
or of higher wages or of a more exciting life. 

It was in these circumstances that the most fatal infections 
of typhus took place. Such extraordinary malignancy of 
typhus happened often when the type of sickness (if indeed 
there was definite disease at all) among the originally ailing 

7—2 



lOO Typhus and other Continued Fevers. 

failed to account for it ; it was the great disparity of condition 
that accounted for it. There were, however, more special 
occasions when a higher degree of malignancy than ordinary 
was bred or cultivated among the classes at large who were 
habitually liable to typhus. But even the old pestilential 
spotted fever which used to precede, accompany, and follow the 
plague itself, was fatal to a comparatively small proportion of 
all who had it. Thus, towards the end of the great London 
plague of 1625, on i8th October, Sir John Coke writes to Lord 
Brooke : '* In London now the tenth person dieth not of those 
that are sick, and generally the plague seems changed into 
an ague\" One in ten is probably too small a fatality for the 
old pestilential fever ; but that is the usually accepted proportion 
of deaths to attacks in the typhus fever of later times. The 
rate of fatality is got, naturally, by striking an average. But 
in truth an aggregate of typhus cases, however homogeneous 
in conventional symptoms or type-characters, was not always 
really homogeneous. We have seen that ninety cases of typhus 
could occur in the slums of Manchester with only two deaths. 
On the other hand there were outbreaks of gaol-fever in which 
half or more of all that were attacked died ; and I suspect that 
the average fatality in typhus of one in ten was often brought up 
by an admixture of cases of healthy and well-conditioned people 
who caught a much more malignant type of fever from their 
contact with those inured to misery. To strike an average is 
in many instances a convenience and a help to the apprehension 
of a truth ; but for the average to be instructive, the members 
of the aggregate must be more or less comparable in their 
circumstances. It has been truly said that there is no common 
measure between Lazarus and Dives as regards their subjective 
views of things ; it is not a little strange to find that they 
are just as incommensurable in their risk of dying from the 
infection of typhus fever. The rule seems to be that the degree 
of acuteness or violence of an attack of typhus was inversely as 
the habitual poor condition of the victim. In adducing evidence 
of the tragic nature of typhus infection conveyed across the 
gulf of misery to the other side, I shall endeavour to keep 
strictly to the scientific facts, leaving the moral, if there be a 
moral (and it is not always obvious), to point itself 

Let us take first the common case of country-bred people 

' Cal. Coke AfSS. Hist. MSS. Commiss. i. 218. 



Ferriar on TypJius in country inimigrant's. loi 

migrating to the towns. Any lodging in a crowded centre 
of industry and trade would be high-rented compared with the 
country cottage which they had left, and they would naturally 
gravitate to the slums of the city. 

"Great numbers of the labouring poor," says Ferriar of Manchester, 
"who are tempted by the prospect of large wages to flock into the principal 
manufacturing towns, become diseased by getting into dirty infected houses 
on their arrival. Others waste their small stock of money without procuring 
employment, and sink under the pressure of want and despair.... The number 
of such victims sacrificed to the present abuses is incredible." And again : 

"It must be observed that persons newly arrived from the country are 
most liable to suffer from these causes, and as they are often taken ill 
within a few days after entering an infected house, there arises a double 
injury to the town, from the loss of their labour, and the expense of support- 
ing them in their illness. A great number of the home-patients of the 
Infirmary are of this description. The horror of these houses cannot easily 
be described ; a lodger fresh from the country often lies down in a bed 
filled with infection by its last tenant, or from which the corpse of a victim 
to fever has only been removed a few hours before^" 

Two instances from the same author will show the severe 
type of the fever. 

The tenant of a house in Manchester, who was herself ill of typhus along 
with her three children, took in a lodger, a girl named Jane Jones, fresh 
from the country. The lodger fell ill, but the fact was kept concealed from 
the visiting physician until her screams discovered her: "She was found 
delirious, with a black fur on the lips and teeth, her cheeks extremely 
flushed, and her pulse low, creeping, and scarcely to be counted." Treat- 
ment was of no use ; she " passed whole nights in shrieking," and in her 
extremity, she was saved, as Ferriar believed, by affusions of cold water. 
Another case, exactly parallel, proved fatal in three days : 

"In 1792 I had two patients ill of typhus in an infected lodging-house. 
I desired that they might be washed with cold water ; and a healthy, ruddy 
young woman of the neighbourhood undertook the office. Though ap- 
parently in perfect health before she went into the sick chamber, she 
complained of the intolerable smell of the patients, and said she felt a 
head-ache when she came down stairs. She sickened, and died of the fever 
in three days 2." 

These are instances of country-bred people, plunging 
abruptly into the fever-dens of cities and catching a typhus 

^ Med. Hist, and Reflect, ut infra. 

^ The following case, which happened five or six years ago, shows disparity of 
conditions in a twofold aspect. A lady from a city in the north of Scotland travelled 
direct to Switzerland to reside for a few weeks at one of the hotels in the High Alps. 
Within an hour or two of the end of her journey she began to feel ill, and was 
confined to her room from the time she entered tlie hotel. An English physician 
diagnosed the effects of the sun ; the German doctor of the place, from his reading 
only, diagnosed typhus fever, which proved to be right, the patient dying with the 
most pronounced signs of malignant typhus. An explanation of the mystery was soon 
forthcoming. The lady had l^een a district visitor in an old and poor part of the 
Scotch city; she had, in particular, visited in a certain tenement-house in a court, 
from which half-a-dozen persons had been admitted to the Infirmary with typhus (an 
unusual event) at the very time when she was ill of it on the Swiss mountain. 



I02 Typhus and other Contimted Fevers. 

severe in the direct ratio of their ruddy, healthy condition. 
Another class of cases is that of persons carrying the atmosphere 
of a gaol into the company of healthy and otherwise favourably 
situated people. Howard gives a case : at Axminster a 
prisoner discharged from Exeter gaol in 1755 infected his 
family with the gaol-distemper, of which two of them died, 
and many others in that town. The best illustrations of the 
greater severity and fatality of typhus among the well-to-do 
come from Ireland, in times of famine, and will be found in 
another chapter. But it may be said here, so that this point in 
the natural history of typhus fever may not be suspected of 
exaggeration, that the enormously greater fatality of typhus (of 
course, in a smaller number of cases) among the richer classes 
in the Irish famines, who had exposed themselves in the work 
of administration, of justice, or of charity, rests upon the unim- 
peachable authority of such men as Graves, and upon the 
concurrent evidence of many. 

Ship-Fever. 

The prevalence of fevers in ships of war and transports 
from the Restoration onwards can be learned but imperfectly, 
and learned at all only with much trouble. Sir Gilbert Blane, 
who was not wanting in aptitude and had the archives of 
the Navy Office at his service, goes no farther back than 1779, 
from which date an account was kept of the causes of death in 
the naval hospitals. But the deaths on board ships of the fleet 
were not systematically recorded until 181 1, when the Board of 
Admiralty instructed all commanders of ships of war to send to 
the Naval Office an annual account of all the deaths of men on 
boards The sources of information for earlier periods are more 
casual. 

The war with France, which dated from the accession of 
William III. and continued until the Peace of Ryswick in 
1697, ^^^ to numerous conflicts with French and Spaniards in 
the West Indies, and to naval expeditions year after year. 
The loss of life from sickness in the British ships for a few years 
at the end of the century was such as can hardly be realized by 
us. Some part of it happened on the outward voyages, but 
by far the greater part of it was from the poison of yellow fever 

' Jjlane, Select Dissertations. London, 1^21, p. i. 



Much Ship-fever abroad zvas Yellozv Fever. 103 

which had entered the ships in the anchorages of West Indian 
colonies. It was probably to that cause that the enormous 
mortality in the fleet under Sir Francis Wheeler was owing. 
After some ineffective operations against the P'rench in the 
Windward Islands in the winter of 1693-4, he sailed for North 
America with the intention of attacking Quebec. This he 
failed to do, having sailed from Boston for home on the 3rd of 
August without entering the St Lawrence. The reason of the 
failure was probably the extraordinary fatality which Cotton 
Mather, of Boston, professes to have heard from the admiral 
himself, namely, that he lost by a malignant fever on the 
passage from Barbados to Boston 1300 sailors out of 2100, and 
1800 soldiers out of 2400 \ 

Another instance comes from Carlisle Bay, Barbados. The 
slave ship ' Hannibal' arrived there in November, 1694, during a 
disastrous epidemic of yellow fever. Phillips, the captain, whose 
journal of the voyage is published^ had great difficulty in 
saving his crew from being pressed into the king's ships, which 
were short of men owing to the yellow fever. Captain Sherman, 
of the ' Tiger,' who convoyed the ' Hannibal' and other 
merchantmen back to England in April, 1695, told Phillips 
that he buried six hundred men out of his ship during the two 
years that he lay at Barbados, though his complement was but 
220, "still pressing men out of the merchant ships that came in, 
to recruit his number in the room of those that died daily." 

These and other similar experiences of yellow fever in the 
West Indies, which might be collected from the naval history, 
do not come properly into this chapter ; and I pass from 
them to ship-fever proper, having indicated how much of the 
loss of life abroad was due to yellow fever. 

Some light is thrown upon the state of health on board ships 
of war on the home station by Dr William Cockburn, physician 
to the fleet, afterwards the friend of Swift, who calls him 
" honest Dr Cockburn." He had a secret remedy for dysentery, 
which he succeeded in getting adopted by the Admiralty, 
greatly to his own emolument for many years after. Dining on 

1 Mather's Magnalia. i vols. Hartford, 1853, i. 226 "Life of Sir William 
Phipps." " Whereof there died, ere they could reach Boston, as I was told by Sir 
Francis Wheeler himself ['but a few months ago'], no less than 1300 sailors out of 
21, and no less than 1800 soldiers out of 24." He had brought iSco troops with him 
from England to Barbados in transports. 

^ Churchill's Collection, vi. 173. 



I04 TypJuLs and other Continued Fevers. 

board one of the ships at Portsmouth, in 1696, with Lord 
Berkeley of Stratton, he brought up the subject of his electuary, 
and arranged for a public trial of it next day on board the 
' Sandwich.' An uncertain number, which looks to have been 
about seven in Cockburn's own account, but became seventy in 
the pamphlet which advertised the electuary after his death, 
were available for the trial and were speedily cured. Cockburn's 
three essays on the health of seamen^ leave no doubt as to the 
extensive prevalence of scurvy and the causes thereof; while 
his references to " malignant fever," although they are, as usual, 
brought in to illustrate some doctrinal or theoretical point, 
give colour to the belief that ship-typhus may have been as 
common then as we know it to have been in the ships at 
Portsmouth and Plymouth, on the more direct testimony of 
Huxham in 1736, and of Lind twenty years later. 

A naval surgeon of the time of William III, and Anne, was 
induced by his enthusiasm for blood-letting in fevers to record 
some of his experiences on board ship^ It was usually the 
lustiest, both of the young, strong and healthy people, and like- 
wise of the elder sort, that died of fevers, the symptoms which 
proved so mortal having been delirium, phrenitis, coma or 
stupor, whether they occurred in the avvo'^oL (of Sydenham) or 
in the avv6')(6l<; (of the same author) : 

"I had observed in a ship of war whose complement was near 500, in a 
Mediterranean voyage in the year 1694, where we lost about go or 100 men, 
mostly by fevers, that those who died were commonly the young, but almost 
always the strongest, lustiest, handsomest persons, and that two or three 
escaped by means of such [natural] haemorrhagies, which were five or six 
pounds of blood" — the point being that the amount of blood drawn by 
phlebotomy should be in proportion to the robustness and body-weight of the 
patient. 

In 1703 and 1704 he was surgeon to two of Her Majesty's 
ships " where a delirium, stupor and phrenitis " were found as 
symptoms of the fevers. In the summer of 1704, cruising in the 
latitudes of Portugal and Spain, the men brought on board from 
Lisbon unripe lemons with which they made great quantities of 
punch. This was the evident cause of a cholera morbus and 
dysentery : " after this we had a pretty many taken with the 

1 W. Cockburn, M.D. An Account of the Nature, Causes, Symptoms and Cure of 
the Distempers that are incident to Seafari7tg People. 3 Parts. London, 1696-97. 

- J. White, M.D. De recta Saiiiiuinis Missione, or, Netv and Exact Observations 
of Fevers, ?'« which Letting of Blood is shew\i to be the true and solid Basis of their 
Cure, Csrc. London, 1712. His chief point, that the strongest and lustiest were most 
obnoxious to malignant fevers, had been urged by Cockburn in 1696. 



A Naval surgeon on S /dp- fever, 1704. 105 

synochus putris, and some with the caitsits " [malignant fever]. 
Most of these fevers went off by a crisis in sweating, " which 
was so large I had good reason to believe it judicatory." In 
several the fevers left on the 9th, loth or nth day, and in 
almost all by the 14th. " About the latter end of July, and 
in August, there were many taken with a delirium and stupor 
or coma, and some with the phrenitis in their fever." Among 
the symptoms was one which we find described for fevers on 
board ship on the West Coast of Africa at the same time — 
" soreness all over as if from blows with a cane," a symptom 
afterwards associated with dengue. " Sometimes the bones (as 
they term it) don't pain them much." In some cases there 
were petechial spots as well as a stupor. In the month of 
August "the fevers with a stupor and phrenitis" came on apace. 
The treatment was to take ten ounces of blood every day from 
the second to the eighth day of the fever, to give tartar emetic 
in five-grain doses at the outset, and to administer cathartic 
glysters in the second half of the fever. " Seeing the lustiest 
men now ran no more hazard of their lives than any other who 
were usually taken with this fever, nor indeed so much, in the 
beginning of September I resolved, after all the phlebotomy was 
done in these fevers, to try the cathartic sooner." Many of 
these who had accustomed themselves to the liberal use of 
spirituous liquors miscarried in the phrenitis. 

White left the navy in 1704 and settled in practice at 
Lisbon, where he saw much fever. He had seen epidemics 
break out in British ships of war at anchor in the Tagus, 
crowded with men and prisoners. One case he mentions in a 
Lisbon woman, with continual synochus, stupor, and petechiae 
on the fifth day : " This was contagious, for she got it by going 
often to assist a gunner of a man-of-war, who came to her house 
with this distemper upon him : for many at the same time on 
board that ship were sick of that disease." Among the causes 
of fever on board ship he mentions the effluvia of the bilge- 
water. 

Exposed to these emanations were "a multitude of people breathing 
and constantly perspiring in a close place, such as a ship's a/lop or lower 
deck next the hould, where is the entry to a certain vacant space near the 
ship's center, which leadeth to the bottom, for gathering all the water 
together which the ship draweth by leakage, and is called the well. Several 
times there is occasion for some people to go down to examine the quantity 
of the water, and in some ships to bore an augur hole to let in as much 
as will preserve a good air. I have often known two or three men killed at 



io6 Typhus and other Continued Fevers. 

a time, as it is said ; and the reason may be understood from what I said 
of the general effects of that fluid in ordinary fever [he is now writing on 
heat apoplexy], where there is not above two or three inches, but just as 
much as may make a surface, almost equal to the square of the well, of 
stagnant salt water which had been a long while in gathering ; and the air 
over the whole allop extremely rarified, and here not at all ventilated^." 

We owe it to the accident of the celebrated Dr Freind 
having accompanied Lord Peterborough's expedition to Spain 
in 1705 that some account has been preserved of the sickness 
among the troops ashore and afloat^. 

The expedition of some 8000 men being then in its second 
year, fever and dysentery were by far the most common diseases, 
so common that " we can hardly turn, whether at sea or in 
camp, without finding them as if our inseparable companions 
and as if domesticated among us." In the summer of the 
previous year there had been much fever both in the ships of 
the fleet and in the camp before Barcelona : " It was of the 
continual kind, though it usually remitted in the day time, and 
seemed to approach nearly to the stationary one which Syden- 
ham has described in the years 1685 and 1686." He then gives 
symptoms, which were on the whole those of the hospital fever 
to be afterwards described from Pringle's medical account of the 
campaigns in 1743-48. Persons of a robust habit were affected 
more than others, and more severely, and carried off sooner. 
The others were generally taken away by a lingering death. 
" Some, when the fever seemed to have been wholly gone off 
lay four or five days without pain or sickness, though weak ; 

^ Lind (Two Papers 07i Fevers and Infection, London, 1763, p. 113) gives an 
instance where the poisonous effluvia of the ship's well did not spread through the 
'tween decks : " The following accident happened lately [written in 1761] in the Bay 
of Biscay. In a ship of 60 guns, by the carpenter's neglecting to turn the cock that 
freshens the bilge-water, which had not been pumped out for some time, a large scum, 
as is usual, or a thick tough film was collected a-top of it. The first man who went 
down to break this scum in order to pump out the bilge-water was immediately 
suffocated. The second suffered an instantaneous death in like manner. And three 
others, who successively attempted the same business, narrowly escaped with life : one 
of whom has never since perfectly recovered his health. Yet that ship was at all 
times, both before and after this accident, remarkably healthy," It was the contention 
of Renwick, a naval surgeon who wrote in 1 794, that it was the stirring of the bilge- 
water in being discharged from the ship's well, or the adding of fresh water to the 
foul, that caused the offensive emanations. "Hence the first cause of febrile sickness 
in all ships recently commissioned." Renwick made so much of the foul bilge-water 
as a cause that he thought the fevers ought to be termed " bilge-fevers." Letter to the 
Critical Reviezver, p. 42. 

^ These particulars are not given in Freind's special work on Peterborough's 
campaign, wliich deals only with the military and political history, but in his Nine 
Commentaries on Fever (Engl. ed. by Dale, London, 1730), and in a Latin letter to 
Cockburn, dated Baixelona, 9 Sept. 1706, which was first printed in Several Cases in 
Physic. By Pierce Dod, M.D. London, T746. 



Sickness in the expedition to Spain, 1705-6. 107 

afterwards being suddenly seized with convulsions of the nerves 
they in a short time expired " — perhaps the phenomenon of 
relapse, which Lind recorded for ship-fever fifty years after and 
was seen among the troops landed from Corunna in 1809. In 
some few the parotids, or abscesses formed about the groin, 
carried off the disease. 

He then gives the case of a lieutenant on board the 'Barfleur.' At first 
he was restless and delirious ; on the 7th and 8th days he had subsultus 
te7tdinu7n J on the 8th day his tongue was sometimes fixed, and his eyes 
sparkled ; on the 9th day, he was wholly deprived of his understanding ; he 
pulled off the fringe of the bed and plucked the flocks ; when he had before 
faultered in his speech, he was sometimes seized with hiccough. But on 
the loth day, after 12 oz. of blood had been drawn from the jugular vein, 
his delirium went off on a sudden, and he began to mend, making a perfect 
recovery. 

Until the middle of the i8th century there are few other 
notices of ship-fever, but it is probable that Huxham's accounts 
of a very malignant typhus among the crews of ships of war 
at Plymouth in 1735 (as well as at Portsmouth according to 
report), and again in 1741, are to be taken as samples of what 
might have been recorded on many occasions \ 



Fever and Dysentery of Campaigns : War 
Typhus, 1742-63. 

The war in Ireland after the accession of William III. 
produced two remarkable instances of war-sickness, which are 
fully given in another chapter. The campaigns of Marlborough 
against the armies of Louis XIV., from 1704 to the Treaty of 
Utrecht in 17 13, appear to have found no historian from the 
medical side, nor does the duke refer to these matters in his 
dispatches or letters, beyond a remark in a letter to his wife 
from near Munich, 30 July, 1704, a fortnight before the battle 

1 Smollett joined the ' Cumberland ' as surgeon's mate in 1740, before she sailed 
with the fleet sent out under Vernon and others to Carthagena. His account in Rodeidck 
Ra7idom of the sick-bay of the ' Thunder ' as she lay at the Nore is doubtless 
veracious : " When I observed the situation of the patients, I was much less surprised 
that people should die on board, than that any sick person should recover. Here 
I saw about fifty miserable distempered wretches, suspended in rows, so huddled 
one upon another that not more than fourteen inches space was allowed for each 
with his bed and bedding; and deprived of the light of the day, as well as of fresh 
air ; breathing nothing but a noisome atmosphere of the inorbid steams exhaling from 
their own excrements and diseased bodies, devoured with vermin hatched in the 
filth that surrounded them, and destitute of every convenience necessary for people in 
that helpless condition." Chap. xxv. He wrote a separate account of the fatal 
Carthagena expedition in a compendium of voyages. 



io8 Typhus and other Continued Fevers. 

of Blenheim : " There having been no war in this country for 
above sixty years, these towns and villages are so clean that 
you would be pleased with them\" 

The war of 1742-48, in which George II. joined Austria 
against France, produced the first good accounts of war typhus, 
on land and on board ship, in the writings of Pringle'*. After 
the battle of Dettingen, 27 June, 1743, the men were exposed all 
night in the wet fields ; during the next eight days five hundred 
of them were attacked with dysentery, and in a few weeks near 
half the army were either ill of it or had recovered from it. The 
dysentery continued all July and part of August, while the 
army lay at Hanau. The village of Feckenheim, a league from 
the camp, was used as a hospital, some 1 500 being quartered in 
it, most of them ill at first of dysentery. The latrines appear to 
have been ill designed and badly kept. " A malignant fever 
began among the men, from which few escaped : for however 
mild or bad soever the flux was for which the person was sent 
to hospital, this fever almost surely supervened. The petechial 
spots, blotches, parotids, frequent mortifications, and the great 
mortality, characterized a pestilential malignity : in this it was 

worse than the true plague Of 14 mates employed about the 

hospital five died ; and, excepting one or two, all the rest had 
been ill and in danger. The hospital lost nearly half of the 
patients ; but the inhabitants of the village of Feckenheim, 
where the sick were, having first received the bloody flux, 
and afterwards the fever by contagion, were almost utterly 
destroyed ^" The survivors from the sick troops in Feckenheim 
were removed to Neuwied, where they were relieved ; " but the 
rest, who were mixed with them, caught the infection." The 
mixed troops were sent still down the Rhine in bilanders, 
during which voyage " the fever became so virulent that above 
half the number died in the boats, and many of the remnant 
soon after their arrival." A parcel of tents sent in these 
bilanders to the Low Countries were given to a Ghent 
tradesman to refit ; he employed twenty-three journeymen 
upon them, " but these unhappy men were quickly seized with 

1 Coxe's Life of MarlboroJigh. Bohn's ed. i. 183. 

- Grainger's essay, Histoi-ia febris anomalae Bataviac anitonnn, 1746, 1747, 1748, 
etc. Edin. 1753, is chiefly occupied with an anomalous "intermittent" or "remittent" 
fever with mihary eruption, and with dysentery. 

•* P'or a full discussion of the relation of dysentery to typhus, see Virchow, 
" Kriegstypus und Ruhr." Vircltaiv' s Arcliiv, Bd. 1, 11. (1871), p. i. 



Sickness of campaigns abroad and at home, 1743-46. 109 

this fever, whereof seventeen died." They had no other com- 
munication with the infected but through the tents. 

"These," says Pringle, "are instances of high malignity. The 
common course of the infection is slow, and only catching to 
those constantly confined to the bad air. Sometimes one will 
have this fever about him for several days before it confines him 
to his bed ; others I have known complain for weeks of the 
same symptoms without any regular fever at all ; and some, 
after leaving the infectious place, have afterwards fallen ill of 
it\" 

After the battle of Fontenoy on 1 1 May, 1745, the army was 
in good health : " the smallpox was the only new disease ; it 
came with the recruits from England, but did not spread ; and 
indeed we have never known it of any consequence in the field." 

On the Jacobite rebellion breaking out in Scotland later in 
the same year, some of the returning troops were ordered to 
disembark at Newcastle, Holy Island and Berwick. They had 
a long voyage, so that a kind of remitting fever which some of 
them had acquired in the autumn in the Low Countries was 
"by the crowds and the foul air of the hold soon converted into 
the jail distemper and became infectious." At Newcastle most 
of the nurses and medical attendants of the extemporized 
hospital were seized with it, of whom three apothecaries, four 
apprentices and two journeymen died. But the most remarkable 
experience was on Holy Island. Of ninety-seven men taken 
out of the ships there, ill of the gaol-fever, forty died, " and the 
people of the place receiving the infection, in a few weeks 
buried fifty, the sixth part of the inhabitants of that island." 
At Nairn and Inverness there was a singular experience in the 
spring of 1746. The ships which brought Houghton's brigade 
to Nairn carried also thirty-six deserters to be tried by court- 
martial at the headquarters at Inverness : these men had 
deserted to the French in Flanders, had been found on board 
of a captured French transport carrying men to aid the Pretender, 
and had been thrown into gaol in England till an opportunity 
arose of sending them to their trial. Three days after the 
landing at Nairn of the force with which these deserters sailed, 
six of the officers were seized with fever and many of the men, 

^ Sir John Pringle, Obs. on the Nature and Ciire of Hospital and Jayl Fever, 
Lond. [750 (Letter to Mead); and his Obs. on Diseases of the Army, Lond. 1752 
(fullest account). 



no Typhtts and other Continued Fevers. 

of whom eighty were left sick at Nairn ; in the ten days that 
the regiment remained at Inverness it sent one hundred and 
twenty more to hospital, ill of the same fever, which became 
frequent also among the inhabitants of the town. " Though the 
virulence of the distemper diminished afterwards in their march 
to Fort Augustus and Fort William, yet the corps continued 
sickly for some time." From the middle of February, 1746, 
when the army crossed the Forth, to the end of the campaign, 
there were two thousand sick in hospital, including wounded, of 
which number near three hundred died, mostly of the contagious 
fever \ 

After the Peace of Aix-la-Chapelle in 1748, the English 
troops embarked at Willemstad for home ; " but the wind being 
contrary, several of the ships lay above a month at anchor, and, 
after all, meeting with a tedious and stormy passage, during 
which the men kept mostly below deck, the air was corrupted 
and produced the jail or hospital fever." The ships that came 
to Ipswich were in the worst state, about four hundred men 
having been landed sick there, most of them ill of this con- 
tagious fever. The infection was at first as active and the 
mortality as great on shore as on board ; but the virulence of 
the fever was at length subdued by dispersing the sick and 
convalescents as much as possible^ 

Monro gives a similar account of the camp sickness among 
the British troops during the campaigns in North Germany in 
1760-63. In the autumn of 1760, before he joined the forces, 
there had been much malignant fever and dysentery : the camp 
at Warburg was near the battlefield (31 July, 1760), where 
many of the dead were scarce covered with earth ; there were 
also many dead horses, and in a time of heavy rains, the camp, 
with the neighbouring villages and fields, was filled with the 
excrements of a numerous army. Not only the soldiers, but the 
inhabitants of the country, who were reduced to the greatest 
misery and want, were infected, and whole villages almost laid 
waste. When Monro joined at Paderborn in January, 1761, he 
found the hospitals overcrowded, and the malignancy of the 
fever thereby much increased, so that a great many died. "The 
1st and 3rd regiments suffered most, owing to all the sick of 
each regiment being put into a particular hospital by themselves, 

' Prinsrle, Diseases of the Army, pp. 40-45. 
- //lid', p. 68. " 



Monro on fevers among the troops, 1761. rii 

which kept up the infection, so that they lost one-third of those 
left ill of this fever, and many of the nurses and people who 
attended them were seized with it." He distributed the sick 
men of the Coldstreams among the houses in the town, and lost 
few in comparison with the ist and 3rd regiments. The con- 
tagion, under this bold policy, did not spread. 

Two points in the symptoms are noteworthy : first the 
occurrence of suppurating buboes of the groins and armpits in 
several ; and, secondly, the frequency of round worms. 

"In this fever it was common for patients to vomit worms, or to pass 
them by stool, or, what was more frequent, to have them come up into the 
throat or mouth, and sometimes into their nostrils, while they were asleep in 
bed, and to pull them out with their fingers. The same thing happened to 
most of the British soldiers brought to the hospitals for other feverish 
disorders as well as this." 

He cannot explain the commonness of round worms in the sick, 
unless it was from the great quantity of crude vegetables and 
fruits eaten, and the bad water. Patients in convalescence often 
suffered from deafness, and from suppurating parotids. Some 
had frequent relapses into the fever, " which seemed to be owing 
to the irritation of these insects," namely the worms. Most of 
those who fell into profuse, kindly, warm sweats recovered, the 
sweats lasting from twelve to forty-eight hours, and carrying off 
the fever. He never saw any miliary eruptions, and only 
sometimes petechiae, or small spots, or marbling as in measles^ 



Ship-Fever in the Seven Years' War and American War. 

Ship-fever would appear to have been at its worst after the 
middle of the i8th century. Dr James Lind joined Haslar 
Hospital in 1758, and brought to the naval medical service 
the same high qualities which Pringle and Monro brought to 
that of the army^ The smaller ships, such as the ' Saltash ' 
sloop, the ' Richmond' frigate, and the ' Infernal' bomb were full 
of fever of the most malignant kind ; of 120 men in the ' Saltash,' 
80 were infected with a contagion much more virulent and 
dangerous than that in the guard-ships. The explanation was 

^ Donald Monro, M.D. Diseases of British Military Hospitals in Germany , fro7n 
Jan. 1 76 1 to the Return of the Troops to England iji 1763. Lend. 1764. The same 
campaign called forth also Dr Richard Brocklesby's QLconomical and Medical 
Observations from 1758 to 1763 071 Military Hospitals and Camp Diseases etc. 
London, 1764. 

- Essay on Preset-ving the Health of Seatnen, Lond. 1757 ; Two papers etc. u. s. 



112 Typhus and other Coiitiimed Fevers. 

that the smaller ships were receiving vessels for the larger ships, 
and were manned from the gaols ; drafts from them carried the 
infection to the guard-ships and to the ships fitting out for 
foreign service. Malignant fever also arose on the voyage home 
from America\ In September and October 1758, after the 
reduction of Louisburg, several of the ships arriving at Spithead 
were infected with a malignant fever ; three hundred men were 
received from them at Haslar Hospital (some with scurvy), of 
whom twenty-eight died. The ' Edgar,' having been manned at 
the Nore from gaols, sailed for the Mediterranean, and lost sixty 
men from fever and scurvy. The ' Loestoffe,' having lain in the 
St Lawrence for eight months in perfect health, took on board 
six convalescent men from Point Levi Hospital before sailing 
for home ; in forty-eight hours, fifty out of her two hundred men 
were seized with fevers and fluxes, and six died on the voyage 
home. The ' Dublin ' on, the homeward voyage from Quebec 
buried nineteen, and on her arrival reported ninety men sick of 
fever, fluxes and scurvy. The ' Neptune ' was said to have lost 
one hundred and sixty men in a few months, and reported 136 
sick. The ' Cambridge,' with 650 men in health, sent three of 
her crew to the ' Neptune ' laid up, to prepare her for the dock ; 
of these three, one on the fifth day became spotted and died, 
and another narrowly escaped with life. The 'Diana' developed 
fever during a rough passage home from America. The 
'St George,' having sailed from Spithead in 1760, met with 
rough weather and had to return on account of sickness. On 
the other hand, Hawke's fleet of twenty ships of the line with 
fourteen thousand men, which defeated the French in November 
1759, kept the Bay of Biscay for four months in the most 
perfect health. 

From I July, 1758, to i July, 1760, there were 5743 admissions 
to Haslar Hospital, the chief diseases being as follows : 

Fevers 2174 

Scurvy 1 146 

Consumption 360 

Rheumatism 350 

Fluxes 245 

Of the fevers some were of an intermittent type, but by far the 
most were continued ship-typhus. Relapses were common, 
even to the sixth or seventh time. The fever varied a good 

' In 1755 a pestilential sickness raged in the North American fleet, the 'Torbay' 
and ' Munich ' being obliged to land their sick at Halifax. 



Ship-fever in i7S7 '■ the epidemic at Brest. 113 

deal in malignity, but never produced buboes, livid blotches or 
mortifications, and seldom parotids. Twenty-four men received 
from January to March 1760 out of the 'Garland' had most of 
them petechial spots accompanied with other symptoms of 
malignity, and of these, five died or 20 per cent. But of 105 
received during the same months from the ' Postilion ' and 
' Liverpool ' only eight died, and those mostly of a flux. The 
infection had little tendency to spread among the attendants at 
Haslar. In the first six months only one nurse died ; in 1759, 
two labourers and two nurses died, one of the nurses by 
infection, having concealed some infected shirts under her bed, 
the other by decay of nature. Of more than a hundred persons 
employed in various offices about the sick there died only those 
five in the course of eighteen months. 

Although Lind's account of ship-fever in the British navy is bad enough, 
he has collected some far worse particulars of foreign ships. Febrile con- 
tagion destroyed two-thirds of the men in the Due d'Anville's fleet at 
Chebucto (now Halifax), in 1746, the complete destruction of which was 
afterwards accomplished by the scurvy. It was ship-fever which ravaged 
the Marquis d'Antin's squadron in 1741, the Count de Roquesevel's in 1744, 
and the Toulon squadron in 1747. He takes the following from Poissonnier's 
Traite de Maladies des Gens de Mer: The fleet commanded by M. Dubois de 
la Mothe sailed in 1757 from Rochefort for Louisburg, Canada, having some 
men sickly. The ships touched at Brest, and sent 400 ashore sick. They 
sailed from Brest on 3 May, and arrived at Louisburg on 28 June. There 
was then sickness in only two ships, but in a short time it appeared in 
all the fleet. On 14 October the fleet sailed from Louisburg for home, 
embarking one thousand sick, and leaving four hundred supposed dying. 
In less than six days from sailing most of the thousand sick were dead. 
When the fleet arrived at Brest on 22 November there were few seamen well 
enough to navigate the ships ; 4000 men were ill, the holds and decks being 
crowded with the sick. The hospitals at Brest were already occupied, two 
ships from Quebec shortly before having sent a thousand men to them. 
Fifteen hospitals were soon filled, attended by five physicians and one 
hundred and fifty surgeons. Two hundred almoners and nurses fell victims. 
The infection passed to the lower class of the citizens, the havoc became 
general, and houses everywhere were filled with the dying and the dead. 
At length it got among the prisoners in the hulks. This dreadful infection 
began to abate in March, 1758, and ceased in April, having carried ofif in less 
than five months upwards of 10,000 people in the hospitals alone, besides a 
great number of the Brest townspeople. The stench was intolerable. No 
person could enter the hospitals without being immediately seized with 
headache ; and every kind of indisposition quickly turned to fatal fever, as 
in the old plague times. The state of the bodies showed the degree of 
malignity that had been engendered : the lungs were engorged with blood, 
and looked gangrenous ; the intestines often contained a green offensive 
liquor, and sometimes worms. Lind's other instances are chiefly of the 
Dutch East Indiamen that anchored at Spithead with fever onboard. In 
Nov., 1770, the ' Yselmonde' bound to Batavia, came to anchor at Spithead, 
and buried a number of men every day; two custom-house officers caught 
the fever and died. He gives two other instances of Dutch ships bound to 

C. II. 8 



1 14 Typhiis mid other Continued Fevers. 

Batavia, which came in to Portsmouth with fever ^. The Dutch were said to 
send annually 2000 soldiers to Batavia, and to lose three-fourths of them by 
the ship-fever before they arrived. In 1769 Lind saw ship-fever in the 
Russian fleet at Spithead. 

Brownrigg, of Whitehaven, gives a good instance of the 
diffusion of typhus in a newly-commissioned ship of war, and 
thence to the civil population, which bears out Lind's favourite 
notion that the gaols and the press.-gang had far-reaching 
effects. In the year 1757 a sloop of war had been hastily 
manned at the Nore to protect the shipping between the Irish 
and Cumberland ports. She reached Whitehaven in May, with 
fever on board. The men were landed and lodged in small 
houses. Brownrigg found about forty lying on the floor of three 
small rooms, very close together, many of them in a dying 
state; seven days after he was himself seized with fever, and 
had a narrow escape with life. The ship's surgeon died of it, 
his mate recovered with difiiculty, two surgeons of the town died 
of it, and two more in Cockermouth. The contagion spread 
widely among the inhabitants of Whitehaven, Cockermouth and 
Workington ^ 

Lind showed to Howard in one of the wards of Haslar 
Hospital a number of sailors ill of the gaol fever; it had been 
brought on board their ship by a man who had been discharged 
from a prison in London, and it spread so much that the ship 
had to be laid up^ 

With the outbreak of the American War we begin to hear 
of still more disastrous epidemics of fever in the English fleets. 
Some instances from Robertson's full collection must suffice*. 
The 'Nonsuch' left England in March, 1777, and fifty of her 
men were carried off by fever before December ; in that month, 
the 'Nonsuch,' ' Raisonable' and 'Somerset' had each from 130 

^ The Gentle77ian^ s Magazine for December, 1772 (p. 589), records the following: 
"The bodies of two Dutchmen who were thrown overboard from a Dutch East 
Indiaman, where a malignant fever raged, were cast up near the Sally Port at 
Portsmouth ; they were so offensive that it was with difficulty that anyone could be 
got to bury them." 

^ W. Brownrigg, M.D. Considerations on preventing Pestilential Contagion, 
London, 1771, p. 36. 

•'' Lind writes in his book on the Health of Seamen, "The sources of infection to 
our armies and fleets are undoubtedly the jails : we can often trace the importers of it 
directly from them. It often proves fatal in impressing men on the hasty equipment 
of a fleet. The first English fleet sent last war to America lost by it alone two 
thousand men." 

"^ R. Robertson, M.D. Observations on yail, Hospital or Ship Fever from the \th 
April, 1776, to the ■^otk April, 1789, made in various parts of Europe and America 
and on the Intermediate Seas. London, 1789. New edition. 



Ship-fever dtiring the Ainerican War, 1774-80. 115 

to 150 men on the sick list, chiefly fever in the ' Somerset,' and 
scurvy in the other two. In April, 1778, the 'Venus,' with a 
crew of 240, was at Rhode Island very sickly ; the surgeon told 
Robertson that they had lost about fifty men of fever, which 
still continued to rage on board : they became sickly from being 
crowded with prisoners and cruising with them on board in bad 
weather. The ' Somerset ' had buried 90 men of the fever since 
she left England, 70 of them being of the best seamen. On 
arriving at Spithead in October, 1779, Robertson found much 
fever in the Channel Fleet which had lately come in, especially 
in the ' Canada,' ' Intrepid, ' Shrewsbury,' London ' and 'Namur,' 
three or four of which were put past service, so much were they 
disabled by sickness. At Gibraltar Hospital from 12 January 
to 31 March, 1780, there were admitted 570 men from twenty- 
seven ships, of whom 57 died; of no sick from the 'Ajax,' 
18 died; of 437 Spanish prisoners, 37 died. Next year, in May, 
1781, at Gibraltar, the 'Bellona' had buried 27 men since she 
left England, and had 108 on the sick list. The 'Cumberland' 
had buried 15; of the ' Marlborough's ' men, 40 had died at 
the hospital. Robertson had to purchase at his own expense 
vegetable acids, fruit and vegetables for the sick. 

Some statistics remain of the loss of men in the navy by sickness in the 
Seven Years' War (1756-62) and in the American War\ The House of 
Commons had ordered a return of the number of seamen and marines raised 
and lost in the former ; but the return was too general to be of much use, the 
number "lost" having included all those men who had been sent to hospital 
and never returned to their ships, all those who had been discharged as 
unserviceable, and all deserters. The number raised was 184,899, and the 
number "lost" 133,708, besides 15 12 killed. The Return by the Navy 
Board for the period of the American War was more specific, slfowing only 
the number of the dead and killed. 

Seamen and Marines raised, dead or killed, during the American War, 
29 Sept., 1774, to 29 Sept., 1780 : 

Year Raised Dead Killed 



1774 


345 


— 


— 


1775 


4,735 


— 


— 


1776 


21,565 


1679 


105 


1777 


37,457 


3247 


40 


1778 


31,847 


4801 


254 


1779 


41,831 


4726 


551 


1780 


28,210 


4092 


293 




175,990 


18,545 


1243 



1 Given by Blane in a Postscript to his paper "On the Comparative Health of the 
British Navy, 1779-1814" in Select Dissertations, London, 1822, p. 62. 



3—2 



1 16 TypJiiLS and other Continued Fevers. 

Fully a tenth part of the men raised were lost by sickness. 
Fever was the chief sickness, and as it happened rarely that more 
than one in ten cases of fever died, it will be easy to form an 
approximate estimate of the proportion of all the men raised 
for the ships that were on the sick list at one time or another 
with fever — nearly the whole, one might guess. 

During the three last years of the period Haslar Hospital 
was constantly full of typhus fever. Admiral Keppel's fleet 
arrived at Spithead on 26 October, 1778, and soon began to be 
infected with contagious fever; before the end of December, 
3600 men had been sent to Haslar, which could make up at a 
pinch 1800 beds. But the great epidemic at Portsmouth was 
the next year, 1779, when the very large Channel Fleet under 
Sir Charles Hardy came in. During the month of September, 
2500 men were received into hospital, and more than 1000 
ill of fevers remained on board for want of room in the hospitals. 
In the last four months of 1779, 6064 sick were sent to Haslar, 
which had 2443 patients on i January, 1780. There was an 
additional hospital at Foston, holding 200, as well as two 
hospital ships holding 600. The infection was virulent during 
the winter, when Portsmouth was crowded with ships ; and in 
the first five months of 1780, when 3751 cases of fever were 
admitted during the decline of the epidemic, one in eight died. 
The following shows how much fever preponderated at Haslar 
Hospital in 1780. In 8143 admissions on the medical side, the 
chief forms of sickness were as follows^ : 



Continued Fevers 


5539 


Scurvy 


1457 


Rheumatism 


327 


Flux 


240 


Consumption 


218 


Smallpox 


42 



Blane gives the instance of the ' Intrepid,' one of the Channel Fleet under 
Hardy in 1779: "Almost the whole of her crew either died at sea or were 
sent to the hospital upon arriving at Portsmouth. This ship, after refitting, 
was pretty healthy for a little time ; but probably from the operation of the 
old adhering infection, she became extremely sickly immediately after 
joining our fleet and sent 200 men to the hospital after arriving in the West 
Indies. Most of these were ill of dysentery^." During a voyage of 
three weeks of the ' Alcide' and ' Torbay' from the Windward Islands to New 
York in September, 1780, nearly a half of the men were unfit. In the 
'Alcide' it was a fever that raged, in the 'Torbay' it was a dysentery^. 

^ Blane, u. s. p. 47, from information supplied by Dr John Lind, of Haslar 
Hospital. 

- Diseases incide)it to Seai/wn, p. r8. '' /bid. p. 34. 



Fever in the East India Company's ships. 



117 



These experiences of fever in the ships of the Royal navy 
continued to the end of the i8th century. In Trotter's time, as 
in Lind's, receiving ships were a source of contagion to others, 
one ship of the kind, the ' Cambridge ' having diffused fever 
among many ships of the Channel Fleet by men drafted from her\ 

Ship typhus was also an incident of the voyages of the East 
India Company's ships, which nearly always carried troops. In 
the voyage of the 'Talbot,' 22 March — 25 August, 1768, with 240 
persons on board, "towards the end of July a fever of a very bad 
kind made its appearance, attended with delirium, low pulse, 
petechiae or livid vibices and haemorrhages from the nose, of which 
one died and three or four escaped hard." The sick were isolated, 
and the infection did not spread. Such outbreaks of typhus were 
not uncommon at sea, although the loss of life from them was 
small beside that from the fevers of Madagascar, Sumatra, 
Batavia and Bengal. The ship typhus usually began on board 
among the soldiers. The most notable point is that relapses 
were common, as Lind also observed at Haslar Hospital ; some 
on board the ' Lascelles' in 1783 (150 attacks among 151 soldiers) 
had relapsed seven times. It does not appear, however, that the 
best class of merchantmen suffered greatly from fevers. Dr Clark, 
who compiled a report of the practice in fevers in the ships of 
the East India Company from 1770 to 1785, had reason to con- 
gratulate the Company on the general healthiness of their fleet : 

"When ships set out at a proper season, when they are not too much 
crowded, when the weather is favourable, and no mismanagement appears, 
fewer lives are lost in these long voyages than in the most healthy country 
villages. And in perusing the medical journals I have the peculiar pleasure 
of finding that many ships have arrived in India without the loss of a single 
life by disease," e.g. the 'Valentine' in 1784, seven months out, with 300 
souls, no deaths, and the 'Barrington' in 1789, no deaths outward bound 2. 

^ Trotter, Medicina Naiitica, I. 6i. His general abstracts of the health of the fleet 
in the first years of the French War, 1794-96, give many instances of ship- typhus. 

^ John Clark, M.D. Observations on the Diseases which prevail in Long Voyages 
to Hot Countries, &=€. London, 1773. 2nd ed. 2 vols, 1792. 

John Lorimer, M.D., published in Med. Facts and Observations, vi. 211, a 
" Return of the ships' companies and military on board the ships of the H. E. I. C. 
for the years 1792 and 1793." 





Outward voyages 


Homeward voyages 


In port 


Crew 


Military 


Crew 


Invalids 


Number of men 
Sick 
Dead 


2657 

1253 
28 


3919 

1751 

50 


2701 

1058 

51 


1075 

282 

27 


1533 
96 



ii8 Typhus and other Continued Fevers. 

On the other hand, these Enghsh reports give incidentally 
the most unfavourable accounts of the Dutch East Indian ships. 
Three Dutch ships, then in Praya Bay, St Jago (Cape de Verde 
Islands), had buried 70 to 80 men each, and had some hundreds 
of sick on board. Another report says : " Before we left Table 
Bay several Dutch ships arrived, some of which had buried 80 
people in the voyage from Holland. None lost less than 40 
men. I am informed that some of their ships last year buried 
200 men " — the causes of the sickness being overcrowding, filth, 
and the slowness of the voyages. One experience of the very 
worst kind happened to an English expedition consisting of the 
1 00th regiment, the 98th regiment, the second battalion of the 
42nd, and four additional companies. They had formed part 
of the force for the reduction of the Cape of Good Hope, whence 
they re-embarked for Bombay. During the voyage from Sal- 
danha Bay a contagious fever and scurvy broke out among the 
troops, who were crowded and badly clothed ; dead men were 
thrown overboard by dozens, and the regiments were reduced 
to a third of their original numbers. Six officers of the looth 
regiment died, and an equal if not greater proportion of those 
of the 98th and 42nd. 

The other chief occasion of ship typhus was the emigration 
to the American and West Indian colonies from Britain and 
Ireland. The Irish emigration was especially active from the 
beginning of the i8th century, owing to rack-renting and 
other causes. Madden^ professed to know that one-third of the 
Irish who went to the West Indies (perhaps he should have 
included Carolina) perished either on the voyage or by diseases 
caught in the first weeks after landing ; and as we know that 
typhus attended the Irish emigration in the 19th century, we 
may infer that the same was the cause of mortality in 
the 1 8th. 

The trouble from ship-fever in the navy was so great all 
through the i8th century that many ingenious shifts were tried 
to overcome it. Towards the end of the century, the favourite 
device was fumigation with the vapour of mineral acids ; one 
such plan, for which the Admiralty paid a good sum, ended in the 
burning of several ships to the water's edge. An earlier plan 
was ventilation of the hold and 'tween decks by means of 

^ Reflections and Resolutions for the Gentlemen of Ireland, p. 28. Cited by Lecky. 



Decline of Ship-fever after 1796. 119 

Sutton's pipes ^, which found a strong advocate in the Rev. 
Stephen Hales, of the Royal Society^ 

Twice in the course of a paper to that learned body'' he asserts 
that the noxious, putrid, close, confined, pestilential air of ships' 
holds and 'tween decks "has destroyed millions of mankind"; 
on the other hand, according to the testimony of a captain of 
the navy, Sutton's pipes had kept his ship free from fever. 
Lind caps this with the case of H.M.S. ' Sheerness,' bound to 
the East Indies. She was fitted with Sutton's pipes, the dietary 
being at the same time so arranged that the men had salt meat 
only once a week. After a very long passage of five months and 
some days she arrived at the Cape of Good Hope without having 
had one man sick. " As the use of Sutton's pipes had been 
then newly introduced into the king's ships, the captain was 
willing to ascribe part of such an uncommon healthfulness in so 
long a run to their beneficial effects ; but it was soon discovered 
that, by the neglect of the carpenter, the cock of the pipes had 
been all this while kept shut*." 

Ship-fever was at length got rid of by .more homely and 
more radical means than scientific ingenuity. Lind had shown 
one root of the evil to lie in the pressing of men just out of gaol. 
Admiral Boscawen, by his unaided wits, discovered another 
means of checking it. He avoided the mixing of fresh hands 
with crews seasoned to their ships, unless when some evident 
utility or necessity of service made it proper ; " and upon this 
principle he used to resist the solicitation of captains, when they 
requested to carry men from one ship to another when changing 
their command^" Towards the end of the i8th century many 
reforms were made in the naval service — in the dietary, in the 
allowance of soap, in keeping the bilges clean, in the use of 
iron and lead instead of timber; so that Blane dates from 
the year 1796 a new era in the health of the navy®. 

^ Sutton, "Changing Air in Ships," Phil. Traits. XLli. 42; W. Watson, M.D. 
ibid. p. 62; H. Ellis, ibid. XLVii. 211. 

^ Ibid. XLix. 332, "Ventilation of a Transport." 

3 Ibid. pp. 333, 339. 

^ Lind, Essay on the Most Effectual Means of Preserving the Health of Seamen in 
the Royal Navy. New Ed. London, 1774, p. 29. 

® Blane, Diseases incident to Seajuen, 1785, p. 243. 

® Id. "On the Comparative Health of the British Navy from the year 1799 to the 
year 1814, with Proposals for its farther Improvement." Select Dissertations, 1822, 
p. I. 



I20 Typhus and other Continued Fevers. 



The "Putrid Constitution" of Fevers in the middle 
third of the i8th Century. 

Resuming the history of fevers among the people at large 
from the great typhus epidemic of 1741-42 to the end of the 
century, we find the conditions somewhat different in the earlier 
and later divisions of the period. The time of prosperity, when 
England exported large quantities of wheat in every year except 
two or three, is reckoned from 17 15 to 1765 ; after the latter 
date England gradually ceased to be an exporting country, 
owing to various causes, including the increase of pasture 
farming and the growth of industrial populations in the northern 
counties. The year 1765 marks the beginning of what has been 
called the Industrial Revolution ; and it is also an important 
point of time in the history of the fevers of the country, for it 
is in the generation after that we obtain all the best information 
on what may be called industrial typhus, in the writings of a 
group of physicians who were at once philanthropic and exact. 
But there was an earlier period of fever, which is somewhat 
difficult to the historian. It is perhaps the last period in which 
Sydenham's language of " epidemic constitutions " seems to be 
appropriate, whether it be that the writers of the time were still 
under his influence, or because the prevalent maladies could not 
well be accounted for in any other way. The constitution in 
question was a " putrid " one. It coincided with the great 
outburst of putrid or gangrenous sore-throat, to be described 
elsewhere ; and it included an extensive prevalence of fevers 
which were also called putrid or nervous, and sometimes called 
miliary. Fevers of the same kind, and with the same miliary 
rash, are described by earlier writers, such as Huxham. Perhaps 
the most correct view of the matter is to consider this type 
of fever as corresponding roughly to the middle third of the 
century, and as having been interrupted by the typhus epidemic 
of 1741-42, during a time of special distress. Besides the great 
outburst of putrid or malignant sore-throat, there was also a 
disastrous murrain of cattle for several years; and at Rouen 
there was a remarkable fever which some English writers of the 
time took to be the highest manifestation of the same " putrid " 
constitution that they discovered also in the English and Irish 
fevers. 



Le Cat on the Roiien epidemic of 1 75 3-54. 121 

The fever at Rouen which Le Cat specially described to the Royal Society 
was an outbreak from the end of November, 1753, to February, 1754. This 
outbreak was only one of a series ; but as it attacked a great number of 
persons of distinction and made great havock among them, it attracted 
unusual notice and was regarded as something new, the rumour spreading 
over Europe that Rouen had been visited by plague. The same fever, 
however, had occurred there in previous years ; and allied forms of sickness, 
of the same gangrenous character, including gangrenous sore-throat, could 
be traced back for twenty or thirty years. It will suffice to mention of these 
the malignant fever which appeared in 1748 and continued in 1749, 175° ^^^ 
175 1. There was a fixed pain in the head, pain about the heart, a low fever 
with delirium, often miliary eruptions, continual faint sweating, drowsiness, 
scanty or suppressed urine, abdominal distension. After death the stomach was 
found "inflamed" at places, as well as the small intestine. In some cases 
there were ulcerations which almost penetrated the coats. The lungs were 
engorged with blood. In one case, of a young woman aged twenty, the 
mesentery was filled with obstructed glands and the intestines mortified 
in different places. In another, almost the whole mesentery was mortified 
and there was an anthrax or carbuncle at the upper fore part of the armpit. 
At the same time some cases of smallpox, with miliary eruption, also had ulcera- 
tions of the stomach, with inflammatory spots on other parts of it and of the 
intestine, the mesenteric glands being enlarged and hard. Some of the 
cases at the Hotel Dieu in 1750 were traced to infection from bales of horse- 
hair ; but the type of the disease in those cases did not differ essentially from 
that of other cases. Some rapidly fatal cases in the winter of 1752-53 had 
suppurative inflammation about the heart. (In 1739 there had been deaths from 
continued fever at the Hotel Dieu, after an illness of six or seven days, marked 
by frequent faintings, small abscesses being found after death in the substance 
of the heart near the auricles.) The fever among the upper classes in the winter 
of 1753-54 was marked, in its most mortal form, by lowness, continued fever, 
pain in the head, cough, sore-throat, nausea, dry black tongue, delirium, 
sweats, stupor, some oppression of the heart, spitting of blood, sometimes 
swelling of the belly, these symptoms being followed often by miliary 
eruption, and sometimes by a slight flux with blood. Many were affected 
with a dejection of spirits, and with a feeling of terror which made them 
tremble at the ordinary sound of the voice. The fever ran a full course of 
thirty or forty days (the miliary eruption coming about the 21st day), while 
death usually ensued about the 25th. The appearances after death were 
remarkable (many bodies were opened): "In some a part of the villous 
coat of the stomach and of the small guts was inflamed ; and the rest of 
these organs were filled with an eruption of the miliary crystalline kind, 
except that it was larger; and there was likewise an obstruction in the 
glands of the mesentery. In others a strong inflammation had seized the 
whole stomach and a small portion of the oesophagus, but the intestines 
were free. ..In those cases where the delirium had continued long and 
violent, we found either ulceration on the stomach, or its villous coat 
separated, together with a great inflammation, and even some gangrenous 
spots, on the other coats of that organ." Some recovered by critical 
abscesses. Others who escaped death by the poison carried its terrible 
effects for many months; their limbs and joints were feeble, and they were 
troubled with vertigo, lassitude and fears ^. 

Exactly covering the period of these fevers at Rouen, there 
were low putrid fevers in London, in Worcestershire, in Ireland, 
and among the English colonists in Barbados. It was certainly 

^ Le Cat, Phil. Trans. XLix. 49. 



122 Typhus and other Continued Fevers. 

not a mere fashion in medicine which produced the accounts of 
a similar fever, for these accounts came from places far apart 
and were independent of each other. Dr Fothergill, of Lombard 
Street, published in the Gentleman s Magazine every month for 
five years a short account of the weather and prevalent diseases 
of London, beginning with April, 175 1, and ending with 
December, 1755. He had the weekly bills of mortality before 
him, and he makes various comments upon them ; but his 
accounts of prevalent diseases are from his own observation and 
by way of illustrating the bills. His first reference to a fever is 
under October, 175 1 : "A slow continual fever, with acute pain 
in the forehead : not many attacked, few mortally." The year 
1752 was remarkably free from fevers until November, when 
we read of a fatal fever which had rheumatic symptoms at first 
(as at Rouen in 1 744), attacking the head later, with coma- vigil 
and a dark-coloured ichor on the tongue and lips. It continued 
into January and February, 1753, proving fatal to several. In 
the summer and autumn months there were fevers of the low, 
depressed kind, sometimes called " remittents," with copious 
sweats, or "slow, remitting, dangerous fever," or "slow, treacherous, 
remittent fever, too often fatal." The references to it are most 
numerous in the months from November, 1753, corresponding 
to Le Cat's Rouen narrative. It was slow and imperceptible 
in its approach, the sick often going about ill for a week before 
seeking advice ; it was attended with profuse sweats which 
never relieved, and was fatal to many. It continued more 
or less through the summer, and from August, 1754, it is again 
prominent. In September, it was the most alarming form of 
disease, and was then commonly vehement in its access, with 
lassitude, and pain in the head and back ; unrelieving sweats 
are again mentioned, with dry tongue, delirium, coma-vigil, and 
death about the I4th-i5th day. Fothergill was at a loss to 
know whether he should order blood to be drawn, owing to the 
low depressed nature of the fever. In February, 1755, the fever 
is still " too much of the nature of those which prevailed in the 
preceding months to allow a repetition of bleeding." In April 
it is called the petechial and miliary fever, the miliary eruption 
being of a white sort with a very noisome scent ; the petechial 
spots turned livid, black and gangrenous ; few patients escaped 
who had been sweated at the beginning. The fever was truly 
malignant, the patient restless from the outset, the sweats 



FotJiergill on the '^ slow remittenf fever in London. 123 

weakening. Fothergill's last entries of it are important, under 
the months of May and June, 1755. In May, 1755, the fevers 
were "for the most part allied to that dangerous remittent 
which has for some years past more or less prevailed in different 
places of this kingdom." In June : " It does not appear that 
either in the hospitals or any part of the city a disease has 
broken out of so dangerous a nature as has been reported. The 
same kind of fever that has long continued in this city with 
some small variations in its type, still remains, but it is by no 
means more frequent than it has been in the preceding months, 
nor is it attended with more unfavourable symptoms." 

It is impossible to say how general over England this fever 
may have been in the years 1751-57. Our fullest accounts 
come from Worcestershire ; but the putrid fever is heard of 
more widely. Thus a short Latin piece in the Gentleman's 
Magazine, dated 14 April, 1755, is on the putrid fever lately 
epidemic, and not yet extinct, in some parts of the county of 
Somerset and adjoining places ; its signs were contagiousness, 
pains of the head and loins, nausea and vomiting, diarrhoea, 
quick weak pulse, purple spots, delirium and coma\ Grainger, 
writing from Edinburgh in 1753, declares his motive for pub- 
lishing an account of the anomalous fever of the Netherlands 
in 1746-48 to be that the same had lately been raging over 
almost the whole of Britain. 

We have some particulars for Kidderminster, which can 
hardly have been exceptional for an industrial town, and 
according to the accounts were true also for villages and market 
towns near. Kidderminster was, in the year 1756, a town of 
about four thousand inhabitants, mostly hand-loom weavers 
of worsted and silk. There were no power-looms anywhere in 
England at that time ; and the condition of the Kidderminster 
weavers' houses was doubtless what that of the Tiverton 
community had been fifteen years before. Many of the weavers, 
we are told, are lodged in small nasty houses, for the most part 
crowded with looms and other utensils^. Many of these houses 
were built on a low flat of the river Stour, whence rose putrid 

^ "Its cause seemed to be something contagious mixed with the contents of the 
stomach and intestines, especially the bile and alvine faeces, which absorbed thence 
contaminates the whole body and affects especially the cerebral functions." Gent. 
Magaz., Article signed " S," 1755, p. 151. 

^ James Johnstone, M.D., senior, Malignant Epideinic Fever of 1756. London, 
1758. 



124 Typhus and other Continued Fevers. 

vapours after floods. Its situation had served to render the town 
specially unhealthy before, as in the epidemic of l']2']-2<^'^. 

The first notice by Dr Johnstone is of a low miliary fever 
from Midsummer 1752 to the end of the year. This was a 
comparatively mild affair, although it carried off several. But 
after Christmas it was succeeded by a fever which would then 
have been classed as of the putrid kind. The first great season 
was in 1753, it ceased in the fine years 1754-55, but came back 
in 1756 and 1757. It began with languor, lowness, flutterings, 
faintness, vague pains in the limbs, a low quick pulse, giddiness 
and slight sickness. Some had a propensity to loose stools 
and to profuse hurtful sweats; some bled at the nose, others 
coughed and spit blood ; some had pain in the throat, and 
crimson-red tongue, the sweat and breath of the sick had a 
strong, offensive, putrid smell. In some of the worst cases livid 
petechiae, large livid blotches, and dark brown spots occurred 
over the trunk and limbs. The successful treatment was by 
mineral acids, bark, port wine, and vesication. " This malignant 
fever was very often (though not constantly) complicated with, 
and in general bore great analogy to the malignant sore-throat 
which at this time prevailed in many parts of England." The 
fever which prevailed during that remarkable year (1753) was 
very evidently contagious, for whole families were either all 
together or one after another seized with it. One of the most 
distinctive symptoms was a tendency to trembling of the whole 
body, as well as leaping of the tendons at the wrists. In some 
the tonsils were beset with aphthous sloughs, and towards the 
decline there would be aphthae of the mouth, but symptomatic 
only, and not the dominant lesion as in the ulcerous sore-throat. 
About the 15th day the fever was generally at its height. The 
miliary eruptions were critical to the few that had them ; the flat 
livid petechiae appeared at all times of the disorder. Johnstone 
then compares the fever with that described by Le Cat at 
Rouen in the winter of the same year ; and although he had 
been unable to satisfy his curiosity by opening any body dead of 
the fever, he felt sure that these dreadful symptoms arose from 

1 Nash, Hist, of Worcestershire, ii. 39, found evidence in the Kidderminster 
registers that the fevers of 1727, 1728 and 1729 had "very much thinned the people, 
and terrified the inhabitants." Watson, " On tire IVIedical Topography of Stourport," 
Trans. Proc. Med. Assoc., II., had heard or read somewhere that fever was so bad in 
Kidderminster in the first part of the i8th century that farmers were afraid to come to 
market. 



yohnstone and Huxham on the '^putrid" fever. 125 

some affection of the stomach and small guts, at first erysipela- 
tous, afterwards gangrenous, and at last truly sphacelous. 

Johnstone's statement that the putrid fever in Worcestershire 
in 1752-53 was often complicated with and bore great analogy 
to the malignant sore-throat is borne out by Huxham's accounts 
for Plymouth during the same season : 

"In all sorts of fevers," he writes, "there was a surprising disposition to 
eruptions of some kind or other [including miliary], to sweats, soreness 
of throat and aphthae." It is hardly possible to make out all his cases of 
"malignant anginose fever" to have been scarlet fever with sore-throat. 
Thus there occurred stench, swelling, and samious haemorrhages "comm.only 
in those that died of malignant anginose fever above described. I have 
known the whole body swell vastly, even to the ends of the fingers and toes, 
with a cadaveric lividity, though almost quite cold, and an intolerable 
stench, even before the person was actually dead, blood issuing at the same 
time from the ears, nose, mouth and guts^." 

The first years of this putrid or miliary fever were not 
seasons of scarcity, there having been no failure of the crops since 
1 741 (unless in Ireland, in the province of Ulster mostly, in 
1744); on the contrary, many of the seasons had been unusually 
fine and abundant, the exports from England of wheat, barley, 
malt and rye in the three years 1748, 1749 and 1750 amounting 
to four million quarters. Prices were at the same time favourable 
to the poorer classes ^ But there had been a destructive murrain 
for several years (30,000 cows are said to have died in Cheshire 
in 175 1), and the harvest of 1756 was a failure. 

To the month of February, 1756, the season had been very 
forward, but the early promise of spring was blighted by cold, 
a wet summer and autumn ensued, the fruit crop was ruined, 
and the corn harvest spoiled by long, heavy rains. A dearth, 
bread-riots, &c. ensued^; but it is to be noted that the revival of 
the dangerous malignant contagious fever began at Kidderminster 
as early as April, becoming much worse after harvest. " Many 
for weeks or months laboured under an uncommon depression 
of spirits, felt their strength abate, with great lassitude, and very 
often a great proneness to faint away." As the summer advanced 
the fever became truly epidemic not only in Kidderminster but 
in many other parts of the West and North-west of England. 

^ Huxham, Dissertation on the Malignant Ulcerous Sore-Throat. Loud. 1757, 
p. 60. 

^ Tooke, History of Prices. Introduction. 

" In Shrewsbury gaol, in 1756, thirty-seven colliers were confined for rioting 
during the dearth. Four of them died in gaol, ten were condemned to death, of 
whom two were executed. Phillips, Histojy of Shrewsbury., 1779, p. 213. 



126 Typhus and otJter Continued Fevers. 

It went through whole families, who succumbed either all together or 
one member after the other, and was carried from place to place by the 
attendants on the sick. "It prevailed chiefly in poor families, where 
numbers were lodged in mean houses, not always clean, but sordid and 
damp. It seemed to affect such poor families most where there was reason 
to think a sufficiency of the necessaries of life, on account of the dearth, had 
for some time been scantily supplied ; yet the other poor persons, given to 
the intemperate use of malt liquors and ardent spirits, were observed to be 
very much liable to its influence. And not a few persons in easy circum- 
stances of life were affected with this fever like others." 

Frost in October checked it, and then measles of a malignant 
type had its turn among the children, the whooping-cough 
succeeding the measles. From November to Christmas the 
putrid fever, which chiefly affected persons from ten to fifty, 
and more women than men, returned with increased force. 
In fatal cases, the face was ghastly, sunken and livid (the 
facies Hippocratica), the patient sweated profusely, but seldom 
became cold till death was at hand. There was an abominable 
cadaverous stench in the breath, perspiration and stools. In 
these cases death took place from the 12th to the 14th day. 

The intense and long frost of the opening months of 1757 
nearly put a stop to the fever at Kidderminster. 

"But in other neighbouring villages and market towns it has since the 
spring hitherto (Dec. 1757) been very frequent in places that were little 
affected with it last year. The families of the poorer sort of people uni- 
versally are the most subject to it. And it is observable that the fever 
in some places first broke out in the parish workhouses, and from thence 
spread among the neighbouring people with great malignity. Wherever it 
has appeared it has given very apparent and fatal evidence of its infectious 
nature 1." 

Parliament was summoned to meet in December, 1756, on 
account of the dearth, which formed the topic of the Speech 
from the throne. The export of corn (which had reached a 
million quarters a year not long before) was prohibited, and the 
use of grain in distilling stopped for two months. The distress 
was more acute in 1757, and was enhanced by the greed of 
corn-dealers and millers, who used French bolting-mills to 
grind the mere husks of wheat, pease, rye and barley together 
into meal. Short, who practised at Sheffield, says that the 
fever in October and November, 1757, "was neither so rife nor 
fatal as in 1741^" It raged fiercely in several towns at a 

' Johnstone, u. s. Short says : " a slow, malignant, putrid fever in some parts of 
Yorkshire, Cheshire, Worcestershire and the low parts of Leicestershire, which carried 
off very many." In Octol^er, 1757, it set in at Sheffield and raged all the winter. 

'■^ Short, Increase and J)ecrease of Mankind in England, etc. London, 1767, 
p. 109. 



'' Piitrid " fevers also in Ireland. 1 27 

distance, " where it went by the name of the miliary fever," and 
was mostly among the poor, half-starved in the dearth of 1756-57. 
It is heard of again in the district of Cleveland in the winter of 
1759-60, where it seems to have been mostly a disease of 
children complicated with sore-throat, and allied more to scarlet 
fever than to the putrid fever of adults'. But at Sunderland, 
near at hand, there was spotted fever at the same time, and 
in Newcastle there was dysentery. 

The accounts of fever in Ireland in the same period as 
in England (see chapter II.) are not without value, as showing 
that the " putrid " or nervous type of fever, contrasting with the 
ordinary typhus of the country, had been remarked there also. 
Rutty and Sims describe, during a certain period, the symptoms 
of the low, putrid fever, sometimes with miliary eruptions, 
identifying it both by name and in character with the fever then 
prevalent in England. The most significant thing in Rutty's 
annals is that there occurred in the midst of the low, putrid 
fever with miliary pustules in 1746, a more acute fever, ending 
after five or seven days in a critical sweat, and relapsing. 
The same fever, not very fatal, reappeared in 1748. Sims brings 
the history of the nervous or putrid or miliary fever in Ireland 
(Tyrone) continuously down to the year 1772, as elsewhere 
related. The remarkable phenomenon of tremors or shakings, 
which most witness to, was seen by him in perfection in the 
year 1771 : 

The tremulousness of the wrists, he says, extended to all the body, 
"insomuch that I have seen the bed-curtains dancing for three or four days, 
to the no small terror of the superstitious attendants, who, on first perceiving 
it, thought some evil spirit shook the bed. This agitation was so constant a 
concomitant of the fever as to be almost a distinguishing symptom." These 
were not the shakings of an ague, for there might be no intermission for 
days^. 

Perhaps the most surprising testimony to the existence of an 
" epidemic constitution " of slow, continued nervous fever comes 
from the island of Barbados. Hillary, who had kept a record of 
the prevalent diseases at Ripon, continued the same when he 
settled in Barbados in 175 1". There can be no doubt as to 

1 Charles Bisset, Essay on the Medical Constitution of Great Britain, i Jan. 1758, 
to Midsummer, 1760. Together with a narrative of the Throat-Distemper and the 
Miliary Fever which were epidemical in the Duchy of Cleveland in 1760. London, 
1762, pp. 265, 270, &c. 

^ James Sims, M.D., Obs. on Epid. Disorders. Lond. 1773, p. i8r. 

^ W. Hillary, M.D., Changes of the Air and Concomitant Epid. Disorders in 
Barbadoes. 2nd ed. , Lond. 1766. 



128 Typhus and other Continued Fevers. 

the appearance of this fever in February 1753, its prevalence 
all over the island for eighteen months, and its disappearance 
in September 1754, when, as he writes, "It now totally dis- 
appeared and left the island, and, I think, has not been seen 
in it since" (1758). He gives the same account of it as the 
observers in England and Ireland, except that he does not 
describe miliary eruptions and describes jaundice in convalescent 
children. It was insidious in its onset (as in London), the 
patient often keeping afoot five or six days ; the symptoms 
included pains in the head, vertigo, torpor, lassitude, vigil, 
delirium, faintings, partial sweats, involuntary evacuations, 
gulpings, tremors, twitchings, catchings, coma and convulsions. 
Recovery was marked by copious equable sweats and plentiful 
spitting. " This slow, nervous fever was certainly infectious, for 
I observed that many of those who visited, and most of them 
that attended the sick in their fever were infected by it, and 
got the disease, and especially those who constantly attended 
them and performed the necessary offices of the sick." It was 
last heard of in the remoter parts of the island. 

Miliary Fever. 

It will have been observed in the foregoing accounts of the 
predominant fevers of the years (roughly) from 1750 to 1760 
that there was often a miliary eruption, but that it was far from 
constant. The constant things were the lowness, depression, 
ill-smelling sweats, tremors of the whole body or of the wrist- 
tendons, and other nervous or ataxic symptoms. But we hear 
more of a miliary eruption in connexion with that than with any 
other period of fevers in the history ; and this was the time 
when a controversy arose as to whether there was in reality a 
distinctive kind of fever marked by miliary eruption. Some of 
the school of Boerhaave contended that the phenomenon of 
miliary vesicles was due solely to the heating and sweating 
treatment of the alexipharmac physicians. De Haen and others 
answered that miliary fever was a natural form, independent of 
the mode of treatment. The Boerhaavian contention may be 
admitted as good for such miliary fevers as were described 
under that name in 1710 by Sir David Hamilton' ; nearly the 

^ Traclahis duplex dc Praxcos KcgiiHs et de Feb7-e Miliari, Lond. 1710. Engl, 
trans), of the latter, Lond. 1737. 



Real and factitious Miliary Fever. 1 29 

whole of his sixteen cases appear to have been made miliary by 
treatment, in so far as they became miliary at all. What this 
physician did was to foretell the approach of miliary symptoms 
in various maladies (about one-half of the cases being of lying-in 
women, and the rest various), and then to prescribe Gascoign's 
powder, Goa stone, Gutteta powder, Venice treacle or other 
diaphoretics, along with diluents and the application of blisters ; 
the miliaria appeared about the breast, neck, and clefts of the 
fingers in due course (tenth to fourteenth day). 

So far as his clinical cases are concerned, the late appearance 
of miliary vesicles, lasting a few days, is sufficiently explained by 
the powerful drenches administered ; and it can hardly be 
doubted that much of what was called miliary fever was of that 
factitious kind. But even in Hamilton's essay we find in- 
dications of a real miliary type of fever ; thus he mentions a 
class of cases which look to be the same as those described by 
Johnstone, Rutty, Sims and others forty years after^ — cases with 
wakefulness, depression, tremblings of the tongue and hands, 
convulsive movements and delirium. He mentions also a 
complication of this with sore-throat in 1704, which destroyed 
many. 

As to the association of miliary eruption with the low putrid 
fever so characteristic of the sixth decade of the i8th century, it 
is asserted by too many and in too various circumstances for 
any doubt as to its reality. There is nothing to show that the 
alexipharmac treatment was the one always used ; and it is not 
certain that some in Ireland and elsewhere who had miliary 
eruption received any medical treatment at all. Again, miliary 
vesicles, not always with perspiration, were commonly found in 
the relapsing fever of Irish emigrants in London during the 
great famine of Ireland in 1846-47, by which time the powerful 
drenches of the alexipharmac treatment had been long disused \ 
The controversy as to the reality of miliary fever was one of the 
kind usual in medicine : certain physicians, of whom Hamilton 
in 1 7 10 was an obvious instance, took up an untenable position ; 
they were answered according to the weakness of their argu- 
ment ; and that has been held in later times to be an answer to 
all who alleged the existence of a type of fever marked by 
miliary eruptions. There can be no question as to a low, 
" putrid " kind of fever in which miliary eruptions were usual ; 
^ Ormerod, Clin. Obs. on Continued Fever. London, 1848. 
C. II. ^9 



130 TypJiJis and other Contimied Fevers. 

but offensive sweats were perhaps more usual, whence the name 
of putrid in a h'teral sense, different from the theoretical sense of 
Willis ; more constant also were the starting of tendons, the 
tremors and shakings, together with very varied hysteric 
symptoms, from which the fevers received the name of nervous. 
Dr John Fordyce in his 'History of a Miliary Fever' (1758) 
really describes under that name the symptoms of the low, 
nervous, putrid fever, often attended with miliary vesicles, which 
had been the common type in England in the years immediately 
preceding, and was a common type for some time after, although 
less is heard of the miliary eruptions in the later history^ 

About the last quarter of the i8th century medical writers 
were inclined to drop the names of nervous and putrid as 
distinctive of certain fevers. Pringle, in his edition of 1775, 
says he had been careful to avoid the terms nervous, bilious, 
putrid and malignant, which conveyed either no clear idea or a 
false one. Armstrong, another army physician, writing in 1773, 
says : " Nervous, putrid, bilious, petechial or miliary, they are 
all of the malignant family ; and in this great town [London] 
these are almost the only fevers that have for many years 
prevailed, and do so still, to the great destruction of mankind. 
For inflammatory fevers... have for many years been remarkably 
rare^" Dr John Moore becomes sarcastic over the variety of 
names given to continued fever, some such generic name as 
Cullen's " typhus," then newly introduced, being what he desired''. 

Haygarth, writing of the Chester fevers in 1772, said that the 
miliary fever had been " supposed " endemic there for more than 
thirty years past, but he thought it probable that the eruption 
had generally, or always, been fabricated "by close, warm rooms, 
too many bed-cloaths, hot medicines and diet." He had seen 
only one case in the epidemic that year, and he believed its 
rarity at that time was due to the treatment by fresh air and by 

^ Historia Febris Miliaris, et de Hcmicrania Dissertatio. Auctore Joanne Fordyce, 
M.D., Londini, 1758. Symptoms at p. 16. In an Appendix Dr Balguy makes the 
following curious division of the miliary vesicles : the white in malignant continued 
fever, the dull red in remittent fever, the "almost efflorescent" in intermittent. 
Fordyce makes them to appear as early as the third day, and to begin to disappear in 
four or six days in favourable cases. 

^ London, 1773, p. 9. See also Sir W. Fordyce's essay of the same year. 

^ John Moore,' M.D., Medical Sketches, Lond. 1786. Part II. "On Fevers." 
Referring to the "putrid" fever in particular, he says that certain unbelievers, of 
whom he was probably one, " assert that mankind are tenacious of opinions, when 
once adopted, in proportion as they are extraordinary, disagreeable and incredible." 
Dr Moore is best known as the author of Zelitco. 



Increase of Fever after the Peace of 1763. 



131 



" such regimen and medicines as are cooling and check putre- 
faction \" We shall see later that Percival, for Manchester, 
contents himself with saying that miliary fevers, which were 
formerly very frequent in that town and neighbourhood, now 
[1772] rarely occur". In Scotland as late as 1782 the type 
was still nervous or low, and hardly ever inflammatory^ 



Mortalities 


in London from fever and alt causes. 




Fever 


All 




Fever 


All 


Year 


deaths 


deaths 


Year 


deaths 


deaths 


I74I 


7528 


32169 


1756 


3579 


20872 


1742 


5108 


27483 


1757 


2564 


21313 


1743 


3837 


25700 


1758 


2471 


17576 


1744 


2670 


20606 


1759 


2314 


19604 


1745 


2690 


21296 


1760 


2136 


19830 


1746 


4167 


28157 


I761 


2475 


21063 


1747 


4779 


25494 


1762 


3742 


26326 


1748 


3981 


23069 


1763 


3414 


26148 


1749 


4458 


25516 


1764 


3942 


23202 


1750 


4294 


23727 


1765 


3921 


23230 


I75I 


3219 


21028 


1766 


3738 


23911 


1752 


2070 


20485 


1767 


3765 


22612 


1753 


2292 


19276 


1768 


3596 


23639 


1754 


2964 


22696 


1769 


3430 


21847 


1755 


3042 


21917 


1770 


3214 


22434 



It is singular to observe that in the five successive years in 
this period with lowest fever-deaths and deaths from all causes, 
the years 1757-61 England was at war on the Continent. A 
similar low fever-mortality corresponded with the wars under 
Marlborough and Wellington. 

The era of agricultural prosperity in England, which had 
its only considerable interruptions in the years 1727-29 and 
1740-42, may be said to have met with a more serious check 
from the bad harvest of 1756. There was a recurrence of 
agrarian troubles in 1764-67, partly through actual scarcity 
caused by the extreme drought of 1764, partly through the 
pulling down of cottages and the discouragement of country 
villages, which Goldsmith has pathetically described in his poem 
of the time. Short says that the country in 1765 was in general 
very healthy but for children's diseases, " In some parts the 
putrid fever roamed about from place to place in the highest 
degree of putrefaction, so as several dead bodies were obliged to 
be buried the same day as they died." The price of provisions 
was excessive, meal riots broke out, and the export of corn was 



^^ Haygarth, Phil. Trans. LXIV. 73. 
" Hutchinson, u. s. 



^ Percival, ibid. LXIV. 59. 



9—2 



132 Typhus and other Contimied Fevers. 

stopped, Parliament having been summoned for the occasion in 
November, 1766'. In 1769, at the time of the formation of 
Chatham's ministry, the same train of incidents recurred, — bread- 
riots, flour-mills wrecked, corn and bread seized by the populace 
and sold at low prices, collisions with the military, the gaols full 
of prisoners ^ The long period of cheapness, having lasted half 
a century, was coming to an end. Moralists and economists 
had much to say as to the meaning of the national distress 
which began to be felt in the sixties. Want of industry, want 
of frugality, want of sobriety, want of principle, said one, had 
brought trouble on the working class. '^ The tumults that have 
lately arisen in many counties of England are no other than the 
murmurs of the people, which have been heard for some years, 
bursting forth at last into riot and confusion." The English, it 
seems, had returned to their old medieval taste for the best food 
they could get ; they would not give up the finest bread, 
although the Irish lived on potatoes, and the French on turnips 
and cabbage : " The ploughman, the shepherd, the hedger and 
ditcher, all eat as white bread as is commonly made in London, 
which occasions a greater consumption of wheat." Women 
must have tea and snufif, though children go naked and starved. 
Another writes : " The poorest people will have the finest 
or none." The enclosures had made a want of tillage. " What 
must become of our poor, destitute of work for want of tillage "i " 
The country had for the most part been sickly, labourers scarce, 
and the farmers not able to get their usual quantity threshed 
out. The profligacy of the poor, profane swearing, etc., are 
remarked uponl 

In the last thirty years of the i8th century the accounts of 



^ Anmtal Register^ 1766, p. 2-20. The King's Speech on 11 Nov. was chiefly 
occupied with the dearth. The use of wheat for distilHng was prohibited by an order 
of Council of 16 Sept. 1766. Gent. Magaz. p. 399. To show the hardships of the 
rural population at this time, Mr Gladstone, in a speech at Hawarden in 1891, read 
the following words copied from a stone set up in the park of Hawarden to com- 
memorate the rebuilding of a mill : "Trust in God for bread, and to the king for 
protection and justice. This mill was built in the year 1767. Wheat was within this 
year at 9^'., and barley at 5.?. Qui. a bushel. Luxury was at a great height, and charity 
extensive, but the poor were starved, riotous, and lianged." 

^ Lecky, in. 115. 

^ Gent. Magaz., series of letters by various hands in 1766. See also a long essay 
in the Annual Register for 1767 (tlien edited by Edmund Burke), " On the Causes and 
Consequences of the present High Price of Provisions," p. 165. Tiie evidence of a 
rise in the standard of living, in the matter of dress and luxuries as well as of food, is 
equally clear from .Scotland in the articles written by the parish ministers for the 
'Statistical Account.' 



Improvements in the residential quarters of London. 133 

fever in England became more detailed as to its circumstances, 
and more numerically precise. I shall accordingly bring 
together all that I can find relevant to fever in London, 
Liverpool, Newcastle and Chester, and thereafter in those towns, 
such as Manchester, Leeds, and others in the North, which were 
specially touched in their public health by the movement known 
as the Industrial Revolution. 



Typhus Fever in London, 1770-1800. 

In the London bills of mortality the item of fevers 
diminishes steadily during the latter part of the i8th century, 
the deaths from all causes diminish, the births come nearer to the 
number of the deaths, and in three years of the last decade they 
exceed them. This statistical result is doubtless roughly cor- 
rect ; but the bills were becoming more and more inadequate to 
the whole metropolitan area ; and even for the original parishes 
which they included they have not the same value for fever in 
the later period as they had for plague at their beginning \ On 
the other hand, from about the year 1770 we begin to have 
more exact medical accounts of fever in London, which are not 
indeed numerically exhaustive, but good as samples of what was 
going on. Whatever improvement there was in the prevalence 
of typhus fever touched the richer classes. The Paving Act of 
1766 is credited with having improved the health of the City, 
and there were many new streets and squares being built in the 
west end that were, of course, free from typhus. It is to these 
desirable residential quarters that the eulogies of Sir John 
Pringle'^ Dr John Moore^ and others apply. The slums of 
London were as yet unimproved, and but little known to the 
physicians. Lettsom, who was one of the first of his class to 
visit among the poor in their homes, has much to say of typhus 
fever ; but he is emphatic that it was nearly all an infection of 
the poor. " In the airy parts of this city," he writes in 1773, 
"and in large, open streets, fevers of a putrid tendency rarely 

1 Yox a judicious estimate of the value of the Parish Clerks' bills of mortality see 
the elaborate paper by Dr William Ogle, yoiirn. Statist. Soc. LV. (1892), 437. 

^ Diseases of the Army. New ed. 1775, pp. 334-5- Pringle admitted, however, 
that "in some of the lowest, moistest and closest parts of the town, and among the 
poorer people, spotted fevers and dysenteries ar-e still to be seen, which are seldom 
heard of among those of better rank living in more airy situations." 

^ Medical Sketches, Lond. 1786, p. 464. 



134 Typhus and other Contimied Fevers. 

arise.... In my practice I have attentively observed that at least 
forty-eight out of fifty of these fevers have existed in narrow- 
courts and alleys." The same is remarked by Currie for 
Liverpool, by Clark for Newcastle, by Percival and Ferriar for 
Manchester, by Haygarth for Chester, and by Heysham for 
Carlisle. 

The quarters of the rich had gradually become detached 
from those of the poor. I have shown this more especially for 
Chester, where the old walls made a clear division ; but it was 
general in the second half of the i8th century\ 

Medical practice lay mostly among the richer classes ; the 
physicians knew little of the state of health in the cellars and 
tenement-houses of large towns. Those physicians who did 
know how much typhus fever there was in these purlieus had to 
enter a caveat against the incredulity of the rest. Dr Currie of 
Liverpool, whose facts I shall give in their place, protested that 
he was not exaggerating ; a protest the more necessary that a 
contemporary of his own, Mr Moss, a middle-class practitioner, 
who wrote a book specially on the medical aspects of Liverpool, 
declares that fever is " rare " in that city, while Currie was 
treating from his dispensary a steady average of three thousand 
cases of typhus every year. In the same years, in February, 1779, 
a physician to the army, Dr John Hunter, who had commenced 
practice in Mayfair, found on visiting in the homes of the poorer 
classes in the west of London cases of fever for which he had no 
other name than the gaol or hospital fever of his military 
experience ; it was so much a novelty to him, apart from 
campaigns or transport ships, that he gave an account of his 
discovery of domestic typhus to the College of Physicians". At 
length he found so many cases steadily winter after winter that 
he had them sent to the infirmary of the Marylebone Work- 
house, The practitioners who knew most of the sicknesses of 
the poor were such as Robert Levett, Dr Samuel Johnson's 

1 Lecky, History of England in the Eighteenth Century, ii. ^^6, generalizes tlic 
facts as follows: "The wealthy employer ceased to live among his people; the 
quarters of the rich and of the poor Ijecame more distant, and every great city soon 
presented those sharp divisions of classes and districts in which the political observer 
discovers one of the most dangerous symptoms of revolution." 

- "This disease, as it appears in jails and hospitals, has been well described by 
.Sir John Pringle; and other authors have given accounts of it on board of ships, 
especially crowded transports and prison-ships, but I do not find that its originating 
in the families of the poor in great cities during the winter has been taken notice of." 
Med. Trans. Coll. Pliys. ill. 345. 



TJie sick poor of London in the I'ith century. 135 

dependant, who lived with the doctor in the house in Gough 
Square. Levett had been a waiter in a Paris cofifee-house 
frequented by the medical fraternity, and had acquired a taste 
for and perhaps some knowledge of the healing art. He made 
his modest living by the small fees or articles of food and drink 
which his poor patients gave him. He had only to issue from 
the back of Gough Square by the courts and alleys behind Fleet 
Street, and he would find in the region between Chancery Lane 
and Shoe Lane hundreds of families seldom visited by a physician 
or by a qualified surgeon-apothecary. The good Levett was 
only one of a class. There had always been such humble 
medical attendants of the poor in London. An Act of the third 
year of Henry VHI. was directed against them at the instance 
of the privileged practitioners ; but the regular faculty is said to 
have proved in the sequel both greedy and incompetent, and 
after thirty years there came another Act, couched in terms that 
the bluff king himself might have indited (31-32 Henry VHI.), 
which asserts those qualities of the profession in so many words, 
and establishes the right of any subject of the king to practise 
minor surgery and the medicine of simples upon his or her 
neighbours. That Act is still part of the law of England, and 
under it Levett exercised a statutory right, perhaps without 
knowing it'. There were many other regions of courts and- 
alleys all round the City on both sides of the water, which must 
have been medically served by such as Levett, if served at all. 
It was there that typhus was found and at length clinically 
described by competent physicians, among the earliest of whom 
was Lettsom. 

The General Dispensary in Aldersgate Street having been 
started in 1770 with one physician, Lettsom was chosen ad- 
ditional physician in 1773, and threw himself into the work with 
great zeaR In the first twelvemonth he saw many cases of 
fever, as in the following table : 



' He has been immortalised by Johnson's verses : 

"Well tried through many a varying year 
See Levett to the grave descend. 
Officious, innocent, sincere, 

Of every friendless name the friend. 
In misery's darkest cavern known 
His ready help was ever nigh;" etc. 
^ John Coakley Lettsom, M.D., Medical Memoirs of the General Dispensary in 
London, April 1773 ^° March 1774. London, 1774- 



136 Typhus and other Conthmed Fevers. 

Lettsoin^s practice in Fevers at the Aldersgate Dispensary. 
1773 1774 



Febris 


< 


^ 
% 


c 

1—1 


1— > 


W) 

3 
< 




ti 




> 




1) 

P 


c 

B 
1— > 






Total in 
12 months 


Died 


hectica 


1 


1 


4 


13 


4 


2 


3 


4 


9 


12 


18 


13 


86 


3 


inflammatoria 


— 


— 













I 


I 


I 







5 




intermittens 


3 


I 


7 


I 


I 


I 


I 


— 


2 


I 


2 


2 


22 


— 


nei-vosa 


4 


3 


4 


H 


7 


TI 


4 


5 


I 


I 


5 


4 


65 


3 


putrida 


14 


19 


14 


25 


14 


21 


34 


22 


II 


6 


7 


5 


192 


8 


remittens 


6 


10 


5 


4 


3 


6 


7 


3 


12 


13 


10 


3 


82 


— 


simplex vel 






























diarium 


— 


2 


I 


6 


2 


5 


4 


5 


— 


— 


— 


4 


29 


— 



The nervous, putrid and remittent fevers, belonging to the same 
group, make up the bulk of the fevers. The hectic fevers were 
almost all of children. The fatal cases of fever were fourteen, 
the fatal cases in all diseases for the year having been forty-four. 
What these putrid, nervous and remittent fevers were, will now 
appear from some of Lettsom's descriptions. Fevers with 
symptoms of putrescency were marked by nausea, bitter taste, 
and frequent vomiting, by laboured breathing and deep sighing, 
offensive breath, sweats offensive and soinetimes tinged with 
blood, almost constant delirium, the tongue dry, the tongue, 
teeth and lips covered with black or brown tenacious foulness, 
thrush and ulceration in the mouth and throat, the urine with a 
dark sediment, the stools excessively nauseous and foetid, and 
blackish or bloody, the eyes horny or glassy, with the whites 
often tinged of a deep blood colour, spots on the skin like flea- 
bites, or larger haemorrhagic vibices, bleeding from the gums, nose 
or old ulcers, hiccup near death, often a cough through the fever. 
Lettsom's treatment consisted in good liquors, Peruvian bark, 
and above all fresh, or " cold " air : " When it is considered that 
putrid fevers originate in close unventilated places, the intro- 
duction of fresh air seems so natural a remedy that I have often 
admired its aid should have been so long neglected \" Accord- 
ingly he persuaded the poor people to open their windows, and 
dragged the sick out of doors as soon as it was safe to do so ; 
the effects, he says, were wonderful. His fifty-one cases are 
most valuable illustrations of the perennial fever in the crowded 
parts of London : " 

^ Nothing coidd be clearer than Dr John Arlmlhnot's reasoning and advice on this 
matter half a century before. 



Lettsom and Grant on TypJms in London. 



m 



Case I is of a man aged forty who had occasion to visit a miserable 
crowded workhouse in Spitalfields. He was instantly seized with such a 
nausea and debility as induced him to keep his room as soon as he got 
home. At the end of a week Lettsom found him in "the true jail-fever, or, 
what is the same, a true workhouse-fever." He had involuntary stools and 
leaping of the tendons, and took more wine in a week than he had done for 
many years. 

Cases 2 to 12 were of several fam.ilies in one house in a court in Long 
Lane, Aldersgate Street, who had been infected by a discharged prisoner 
from Newgate. Other cases follow, where the infection was caught from 
visiting the sick. In Case 17, Lettsom applied blisters "owing to the 
importunity of the friends," but without advantage. Case 30, on 26th 
October, 1773, was of a family of six persons near Christ Church, Lambeth, 
father, mother, boy of seventeen, child of two (slight attack) and two maids. 
Other localities were courts off Whitecross Street, Jewin Street, Little 
Moorfields, Chiswell Street, and St Martin's-le- Grand. Case 43 was of a 
woman, aged thirty, in Bunhill Row; she attended a relation who died of a 
putrid fever, and was herself attacked ; her eyes were bloodshot, her skin 
marbled and interspersed with a general deep-coloured eruption, her cheeks 
and nose mortified. Cases 44-47 were of people in a "very helpless situa- 
tion" in Gloucester Court, Whitecross Street. 

The year 1773, to which these experiences in a small part 
of London relate, was one of high febrile mortality, according 
to the Bills. Two years after, Dr William Grant was moved to 
write an ' Essay on the Pestilential Fever of Sydenham, com- 
monly called Gaol, Hospital, Ship and Camp Fever\' which, as 
he said in his preface, " I often see in this city : and though so 
common and fatal, appears not at present to be generally under- 
stood." It was, he says, "an indigenous plant, frequent in this 
city, being produced by close confinement ; but it often passes 
unnoticed, because unknown." The deaths by "fever" in the 
London Bills were as follows until the end of the century : 





Deaths from 


Fever and from all causes 


ifi London, 






Fever 


All 




Fever 


All 


Year 


deaths 


deaths 


Year 


deaths 


deaths 


177I 


2273 


21780 


1786 


2981 


20454 


1772 


3207 


26053 


1787 


2887 


19349 


1773 


3608 


21656 


1788 


2769 


19697 


1774 


2607 


20884 


1789 


2380 


20749 


1775 


2244 


20514 


1790 


2185 


18038 


1776 


1893 


19048 


179I 


2013 


18760 


1777 


2760 


23334 


1792 


2236 


20213 


1778 


2647 


20399 


1793 


2426 


21749 


1779 


2336 


20420 


1794 


1935 


I924I 


1780 


2316 


20517 


1795 


1947 


2II79 


1781 


2249 


20719 


1796 


1547 


19288 


1782 


2552 


I7918 


1797 


1526 


I7014 


1783 


2313 


19029 


1798 


1754 


1815s 


1784 


1973 


17828 


1799 


1784 


18134 


1785 


2310 


18919 

1 Lend 


1800 
on, 1775. 


2712 


23068 



138 TypJiiis and other Continued Fevers. 

There were higher figures in the years immediately before 
177 1, the years to which the generahties of Fordyce and Arm- 
strong relate. There is a decline in the fever-mortality towards 
the end of the century; but it is just from the years 1799-1800 
that we have an account by Willan of the prevalence and con- 
ditions of London typhus, than which nothing can well be 
imagined worse. The intermediate glimpses we get of typhus in 
London in the writings of Dr Hunter, physician, and of Dr James 
Sims, show that the disease was perennial. 

"In the month of February, 1779," says Hunter 1, "I met with two 
examples of fever in the lodgings of some poor people whom I visited that 
resembled in their symptoms the distemper which is called the jail or 
hospital fever. It appeared singular that this disease should show itself 
after three months of cold weather. Being therefore desirous of learning 
the circumstances upon which this depended I neglected no opportunity 
of attending to similar cases. I soon found a sufficient number of them for 
the purpose of further information. It appeared that the fever began in all 
in the same way and originated from the same causes. A poor family, 
consisting of the husband, the wife, and one or more children, were lodged 
in a small apartment not exceeding twelve or fourteen feet in length, and as 
much in breadth. The support of them depended on the industry and daily 
labour of the husband, who with difficulty could earn enough to purchase 
food necessary for their existence, without being able to provide sufficient 
clothing or fuel against the inclemencies of the season. In order therefore 
to defend themselves against the cold of the winter, their small apartment 
was closely shut up, and the air excluded by every possible means. They 
did not remain long in this situation before the air became so vitiated as to 
affect their health and produce a fever in some one of the miserable family. 
The fever was not violent at first, but generally crept on gradually... soon 
after the first a second was seized with the fever, and in a few days more the 
whole family perhaps were attacked, one after another, with the same 
distemper. I have oftener than once seen four of a family ill at one time 
and sometimes all lying on the same bed. The fever appeared sooner or 
later as the winter was more or less inclement, as the family was greater or 
smaller, as they were worse or better provided with clothes for their persons 
and beds, and with fuel, and as their apartment was more or less confined. 
The slow approach of the fever, the great loss of strength, the quickness of 
the pulse with little hardness or fulness, the tremors of the hands, and 
the petechiae or brown spots upon the skin, to which may be added the 
infectious nature of the distemper, left no doubt of its being the same with 
what is usually called the jail or hospital-fever." 

Dr James Sims, who had seen much of Irish typhus in 
Tyrone in his earlier years, and had removed to London, wrote 
of typhus among the poor there in 1786, ten years before the 
more systematic and more circumstantial descriptions by Willan^ 

1 Med. Trans, of the Coll. Phys. Land. in. (1785), .^5 : "Observations on the 
Disease commonly called the Jail or Hospital Fever." By John Hunter, M.D. , 
physician to the army. 

' James Sims, M.D., "Scarlatina anginosa as it appeared in London in 1786," 
Mem. Med. Soe. I.ond. I. 414. Willan, wlio saw the same epidemic of scarlatinal 
sore-throat in I^ondon in 178C, believed that the angina was also "connected with a 



Willan on Typhus in London, 1796- 1800. 139 

This fever was exceedingly mortal, several medical men, 
he had reason to believe, falling sacrifices to it. Sims never 
saw the cases till the 7th or 8th day, when they were desipient, 
insensible, with pulse scarcely to be felt and not to be counted, 
all having petechiae. None had scarlet rash or sore-throat. 
They sank and died quietly ; the strongest cordials did not 
produce the smallest effect, and blisters in many did not even 
raise the skin\ 

It is in the year 1796 that we begin to have the full and 
accurate records by Willan of the prevailing diseases of London 
month by month as he saw them at the Carey Street Dispensary, 
situated in the crowded quarter between Holborn and the Strand ^ 
His first reference to typhus is as follows : 

" In September, also, fevers usually appear which from their commence- 
ment exhibit symptoms of malignancy ; being attended with a brown dry 
tongue, violent pain of the head, delirium, or coma, deep-seated pains of the 
limbs, petechial spots and haemorrhagy. These fevers become highly 
contagious, especially when they occur in close, confined situations, and 
in houses where little attention is paid to ventilation or cleanliness. The 
disease is extended by infection during the months of October and November, 
but its progress is generally stopped by the frosts of December." 

Willan says little more of fever in London until September, 

1798, when these contagious malignant fevers became more 
numerous, both in the city and adjacent villages, than had been 
known for many years before ; also the fever was more fatal 
than usual, one in five or six dying, whereas one in seven was 
formerly a very unfavourable death-rate, and one in twenty not 
unknown. Haemorrhages, aphthae, diarrhoea, starting of the 
tendons, picking the bedclothes, violent delirium, ending in deaf- 
ness, stupor, hiccough and involuntary evacuations, were the 
usual accompaniments of this fever. In the corresponding months 
of 1799 he recurs to the symptoms of this "malignant contagious 
fever," and depicts typhus as clearly as may be. In September, 

1799, it was "attended with a dull pain of the head, great debility 
or sense of lassitude and pains referred to the bones, tremblings, 

different species of contagion, namely, that of the typhus or malignant fever originating 
in the habitations of the poor, where no attention is paid to cleanliness and ventilation." 
Cutaneous Diseases, 1808, p. 333. 

_ 1 The rumour of London fevers seems to have reached Barker, who kept an 
epidemiological record at Coleshill. Referring to the winter of 1788-89, he says: 
"At this time there were dreadful fevers in London, fatal to many, and a very 
infectious one in Coventry, of which many among the poor died, most of them being 
delirious, and many phrenetical." 

^ Robert Willan, M. D., Reports on the Diseases of London, particularly during 
the years 1796-97-98-99 and 1800. London, t8oi. 



140 Typhus a) id other Continued Fevers. 

restlessness with slight delirium, a querulous tone of voice, a 
small and frequent pulse, heat of the skin, thirst and a fur upon 
the tongue, first of a dirty white colour, but turning in the latter 
stage of the disease to a yellowish brown. In this form the 
fever continued thirteen days without any dangerous symptoms, 
and then suddenly disappeared, leaving the patient, for some time 
after, languid and dispirited. All the individuals of a family 
were successively affected with the same train of symptoms ; 
many of them so slightly as not to be much confined to their 
beds." In October and November he describes the symptoms 
of the disease in a more dangerous form. By this fever, he was 
informed, some houses of the poor had been almost depopulated, 
the infection having extended to every inmate. " The rumour 
of a plague was totally devoid of foundation." 

He then describes the state of the dwellings where such fevers 
occurred — the unwashed bed-linen, the numbers in one bed, the 
rooms encumbered with furniture or utensils of trade, the want 
of light and air in the cellars and garrets and in the passages 
thereto, the excremental effluvia from the vault at the bottom 
of the staircase. It cannot be wondered at, he concludes, that 
contagious diseases should be thereby formed, and attain their 
highest degree of virulence ; and he estimates that " hundreds, 
perhaps thousands " of labourers in and near London, heads of 
families and in the prime of life, perished annually from such 
fevers. He denies that his account is exaggerated, and appeals 
for the truth of it to medical practitioners whose " situation or 
humanity has led them to be acquainted with" the localities \ 

Typhus in Liverpool, Newcastle and Chester in the 
last quarter of the i8th century. 

Liverpool, in the last quarter of the i8th century, came next 
in size to London, having a population (in 1790) of 56,000 to 
the capital's estimated 800,000. According to a medical author, 

^ He names specially some streets of St Giles's parish, the courts and alleys 
adjoining Liquorpond Street, Hog-Island, Turnmill Street, Saffron Hill, Old Street, 
Whitecross Street, Golden Lane, the two Bricklanes, Rosemary Lane, Petticoat Lane, 
Lower East Smithfield, some parts of Upper Westminster, and several streets of 
vSouthwark, Rolherhithe, etc. "I recollect a house in Wood's Close, Clerkenwell, 
wherein the fomites of fever were thus preserved for a scries of years; at length an 
accidental fire cleared away the nuisance, h. house, notorious for dirt and infection, 
near Clare-market, afforded a farther proof of negligence : it was obstinately tenanted 
till the wall and floors, giving way in the night, crushed to death the miserable 
inhabitants." 



Cnrrie on TypJins in Liverpool, 1780-96. 141 

whose experiences lay among the middle classes, it was every- 
thing that could be wished in the way of healthfulness and 
prosperity ; but it had a dark side as well. About 7,000 of the 
people lived in cellars underground, and nearly 9,000 in back 
houses, in small confined courts with a narrow passage to the 
street. "Among the inhabitants of the cellars," says Currie^ 
"and of these back houses, the typhus is constantly present ; and 
the number of persons under this disease that apply for medical 
assistance to the charitable institutions, the public will be 
astonished to hear, exceeds three thousand annually... In sixteen 
years' practice I have found the contagious fever of Liverpool 
remarkably uniform among the poor. Seldom extending itself 
in any considerable degree among the other classes of the 
community, it has been supposed that Liverpool was little 
subject to fever ; but this will be shewn from authentic docu- 
ments to be a great and pernicious error." At the Dispensary 
in the year 1780 the cases of typhus averaged 160 per month, 
the numbers being as remarkably steady from month to month 
as from year to year. In the ten years from i January, 1787, to 
31 December, 1796, 31,243 cases of fever were entered on the 
books of the Dispensary, an average of 3124 per annum ^ 

Of 213,305 cases of all diseases at the Dispensary in seven- 
teen years, 1780 to 1796, 48,367, nearly one-fourth, were labour- 
ing under typhus. Supposing that these were all the cases of 
typhus in Liverpool, and that i in 15 died, we should have some 
150 deaths from typhus in a year. Supposing also that typhus 
was relatively as common at that time in London, it will follow 
that nearly all the deaths under " fever " in the bills of mortality 
might well have been from typhus fever; for London in its 
several densely populated out-parishes was the fever-quarter of 
Liverpool a dozen times over^. 

^ Medical Reports on the Effects of IVate}-, Cold and Wai-m, as a Remedy in Fever 
and other Diseases. 2nd ed., 1798. It need hardly be explained that Dr Currie was 
competent on fevers, his use of the clinical thermometer marking him as a man of 
precision. He is best known to the laity as the biographer of Robert Burns and the 
generous helper of the poet's widow and family. 

- " If it be supposed," says Currie, "that some cases may be denominated typhus 
by mistake, let it be considered how many cases of this disease do not appear in the 
books of the Dispensary, though occurring among the poor, being attended by the 
surgeons and apothecaries of the Benefit Clubs to which they Iselong." 

^ Moss [A Familiar Medical Survey of Liverpool, 1784), who had not the same 
means of knowing the prevalence of typhus in Liverpool as Currie, declares that 
' ' there has been but one instance of a truly malignant fever happening in the town 
for many years; it was in the autumn of 1781, and appeared in Chorley Street, which 
is one of the narrowest and most populous streets in the town, and nine died of it in 



142 Typhus and other Coiitimicd Fevers. 

The Newcastle Dispensary was opened in October, 1777, by 
the exertions of Dr John Clark, who was in correspondence with 
Lettsom in London \ Dr Clark had been in the East India Com- 
pany's service, and had seen much of ship-fever and of the fevers 
of the East. During a visit to his home in Roxburghshire in 
the summer of 1770, between his voyages, he attended several 
persons in continued fever. When he settled at Newcastle he saw 
the worst kinds of contagious fever, in workhouses and " in the 
sordid and crowded habitations of the indigent." Putrid fever, 
or typhus, was by far the most common disease attended from 
the new dispensary, although less than at Liverpool, the opera- 
tions of the charity being on a much smaller scale. It was seldom 
out of Newcastle a whole year; and in some years, as 1778, 
1779, 1783, 1786 and 1787 it was unusually rife in particular 
districts, often attacking whole families. Scarlet fever was 
epidemic and very fatal in 1778 and 1779, while dysentery 
attacked great numbers of the poor in the autumns of 1783 and 
1785. The following Table shows the principal diseases attended 
from the Dispensary during the first twenty-three months of its 
working, i Oct. 1777, to i Sept. 1779: 

Newcastle Dispensary 1777-79. 





Cases 




Too far 






visited 


Cured 


advanced 


Dead 


Putrid fever 


391 


357 


9 


16 


Ulcerated sore-throat 


146 


125 


II 


9 


Dysentery- 


72 


55 


5 


4 


Smallpox 


45 


29 


■3 


6 



From I Oct. 1777, to i Sept. 1789, the cases of typhus visited 
were 1920, of which 121 were fatal. During the winter of 1790 
and the spring and summer of 1791 it was prevalent amongst 
the poor, and was frequently introduced into genteel families 
and sometimes even into those of the first distinction. That 
outbreak was supposed to have been generated in the Gateshead 
poorhouse. For some time its ravages were confined chiefly to 
the low, ill-aired, narrow street called Pipewell Gate. In Sep- 

one week ; it was only of short duration, and did not spread in any other part of the 
town." He admits that the liabitations of the poorer class were confined, being 
chiefly in cellars; yet the diet of the sober and mdiistrioiis is wholesome and sufficient, 
the comfortable artizans being ship-carpenters, coopers, ropers and the lilte. 

^ John Clark, M.D., Observations on the Diseases which prevail in Long Voyages, 
&c. "ind cd., I,ond. 1792; Account of the Newcastle Dispensary f7-07n its Commence- 
//lent in 1777 to March i"]^^, Newcastle, 1789; and subsequent Annual Reports. 



'Haygavth on Typhus in Chester, 1773. 143 

tember it made its appearance in Newcastle ; at first the 
contagion was easily traced from Pipewell Gate, and afterwards 
from one house to another. In that outbreak, 188 poor persons 
were visited from the Newcastle Dispensary, the Gateshead 
poor having been attended by the parochial surgeon. Clark's 
ten cases recorded of the epidemic were all of people in good 
circumstances. The Dispensary Tables show cases of typhus 
every year down to 1850, the largest totals being in 1793 (374, 
18 deaths), 1801 (435, 20 deaths), and 1819(368, 14 deaths); and 
these, we may take it, were but a small fraction of all the cases 
in Newcastle. 

Perhaps the most unexpected revelation of typhus is at 
Chester, from the time when Haygarth began to write upon its 
public health in 1772. Chester was then one of the most 
desirable places of residence in England. Boswell wrote to 
Johnson, " Chester pleases me more than any town I ever saw." 
The old city within the walls was occupied by a superior class 
of residents, including the cathedral clergy, county families, 
retired officers and Anglo-Indians, professional men, merchants 
and tradesmen. It had the best theatre out of London. 
Squares, crescents and broad streets were replacing most of the 
old buildings. The six parishes that lay entirely within the 
walls had a population, in 1774, of 3502, and an annual average 
death-rate (in the ten years 1764 to 1773) of i in 58 or I7'2 per 
1000, the central parish of St Peter having a rate of i in 62, and 
the cathedral parish i in %'j. It passed as one of the healthiest 
cities in the kingdom, being far before Shrewsbury and Notting- 
ham, to say nothing of the large towns where the burials 
exceeded the baptisms. But its moderate death-rate over all, 
I in 42 living, would have been much lower but for the four 
poor suburban parishes, with a population of 11,211, which had 
a death-rate of i in 35. Haygarth gives a deplorable account 
of them. The houses were small, close, crowded and dirty, ill 
supplied with water, undrained, and built on ground that 
received the sewage from within the walls. The people were 
ill-fed and they seldom changed or washed their clothes ; when 
they went abroad they were noisome and offensive to the smell. 
Many of them worked on the large farms around Chester, others 
at shipbuilding and shipping (Chester had then a considerable 
foreign trade), others at the mills and markets, others at a 
nail-factory, while others were employed by the tradesmen 



144 Typhus and other Continued Fevers. 

within the walls. Fever seems to have been perennial among 
them, the deaths from typhus having been 23 in 1772, 33 in 
1773 and 35 in 1774. "In these poor habitations," says Hay- 
garth, " when one person is seized with a fever, others of the 
family are generally affected with the same fever in a greater or 
less degree." It became rifer than usual in August, 1773, and 
attacked 285, proving fatal to 28, or to one in ten. It had the 
common symptoms of malignant fevers produced by human 
effluvia, and particularly affected the head with pain, giddiness 
and delirium. It attacked in general the lowest, few of the 
middle rank, and none (or only one) of the highest rank \ 

Chester had no manufactures. Its population had grown 
rapidly of late, as that of Liverpool had grown, the poorer 
classes being the prolific part of the community ; but it had no 
share in the industrial revolution, it did not employ its women 
and children in factories, and it was in some respects better than 
Leeds, Warrington, Manchester, or Carlisle. It is a good illus- 
tration of a town growing rapidly without manufactures, and of 
a community divided by the old walls into two quite distinct 
sections, a rich and a poor. Such had been the drift of things 
in England apart from the industrial revolution ; but it is the 
latter which furnishes the best illustrations of a poor prolific 
populace, of a growing struggle, and of the attendant typhus 
fever. 



Fever in the Northern Manufacturing Towns, 1770-1800. 

The prosperity of the first two-thirds of the i8th century 
had been attended with a very small increase of population. 
From 1700 to 1750 the numbers in England are estimated to 
have grown no more than from about six millions to six millions 
and a half The fecundity of many rural parishes was swallowed 
up by emigration to the American and West Indian colonies, 
by the army and navy, and by the great waste of life in London 
and some other towns. The increase was nearly all north of 
the Trent, while the old weaving towns of the south-west had 
actually declined. Gloucestershire, Somerset and Wilts were 
the most crowded counties in 1700. During the next fifty 

' Ilaygartli, Phil. Trans. LXIV. 67; Hemingway, History of Chester, l. 3,^\ seq. 



The Industrial Revolution. 145 



years, the greatest increase 


was as 


in the fol 


lowing 


estimate ^ : 






Increase 




1700 


1750 


per cent. 


Lancashire 


166,200 


297,400 


78 


West Riding of Yorks, 


236,700 


361,500 


52 


Warwickshire 


96,600 


1 40,000 


45 


Durham 


95,500 


135,000 


41 


Staffordshire 


117,200 


1 60,000 


36 


Gloucestershire 


155,200 


207,800 


34 



In the counties where population had increased most, much 
of the increase was still rural or semi-rural. Defoe describes 
how the land near Halifax was divided into lots of from two to 
six or seven acres, hardly a house out of speaking distance from 
another, at every house a tenter, and on almost every tenter a 
piece of cloth, or kersey or shalloon. Every clothier kept one 
horse at least, to carry his manufactures to the market, and 
nearly every one kept a cow, or two or more, for his family. 
The houses were full of lusty fellows, some at the dye-vat, some 
at the looms, others dressing the cloths, the women and children 
carding or spinning, being all employed from the youngest to 
the oldest: not a beggar to be seen, nor an idle person". We 
have no accounts of the health of this population, except 
Nettleton's statistics of smallpox in and around Halifax in 1721 
and 1722, given elsewhere, and the "epidemic constitutions" 
recorded by Wintringham at York during the same period, and 
by Hillary at Ripon. 

Before the earliest of the inventions of spinning by machinery, 
the weavers were gathering to the towns of Yorkshire, Lancashire 
and other counties north of the Trent. The spinning-jenny of 
Hargreaves was wrecked by a Blackburn mob in 1768, and a 
mob wrecked the cotton-mill built by Arkwright at Chorley 
eleven years later. This was decidedly a time of movement 
from the country to the towns, a movement which preceded the 
spinning ingenuity of the sixties and may have been stimulated 
by the earlier use of the fly-shuttle in weaving. 

^ Arnold Toynbee, Lechires on the Industrial Revolution of the i%th Century, etc. 
London, 1884. 

" Toynbee (u. s.) says of the time before the mills were built : "The manufacturing 
population still lived to a very great extent in the countiy. The artisan often had his 
small piece of land, which supplied him with wholesome food and healthy recreation. 
His wages and employments too were more regular. He was not subject to the 
uncertainties and knew nothing of the fearful sufferings which his descendants were to 
endure from commercial fluctuations, especially before the introduction of free trade." 

c. n. 10 



146 Typhus mid other Continued Fevers. 

Much of the country round Manchester, though it doubtless 
retained those farm-houses, hedgerows, and field paths which 
come into the idyllic opening of ' Mary Barton ' more than half 
a century later, was " crowded with houses and inhabitants," as 
Percival says : so populous were the environs of Manchester 
that every house in the township had been found by a late 
survey to contain an average of six persons. The proportion of 
deaths was less than in 1757; but that was chiefly due to the 
accession of new settlers from the country, which raised the 
ratios of marriages and births \ Manchester had increased 
from a population of about 8000 in 1717 to one of 19,839 
(inclusive of Salford) in 1757. When the inhabitants were next 
counted in 1773, they were found to be 22,481 in Manchester 
(5317 families in 3402 houses) and 4765 in Salford (1099 famihes 
in 866 houses). According to Percival, who gives these figures, 
the death-rate in 1773 was i in 28*4, the births exceeding the 
deaths by forty in a year. The poor, he says, were now better 
lodged, and some of the most dangerous malignant distempers 
were less violent and less mortal. Manchester, however, was 
still an unhealthy place compared with the country, especially 
to young children. Thus, the thirty-one townships in the parish 
of Manchester contained, exclusive of the city, 13,786 inhabitants 
(2525 families in 2371 houses), and of these only i in 56 died 
annually (compared with i in 28 in the city) — the births being to 
the deaths as 401 to 246 in the year 1772. 

Again, the bleak upland parish of Darwen with a population 
in the year 1774 of 1850 souls mostly occupied in the cotton 
manufacture, had, during the seven years before, more than 
twice as many baptisms as burials (508 to 233), the birth-rate 
(i in 25*5) being high and the death-rate (i in 56) low. 

Leeds had a population of some six or seven thousand at the 
time of the Civil Wars, and lost 1325 in nine months of the year 
1645 from plague, all of them the poorer class. A generation or 
two later, in the time of Thoresby's ' Diary,' it was a centre of 
the cloth trade ; and it appears to have grown steadily through- 
out the 1 8th century. In 1775 it had a population of 17,117. 
We hear from Lucas of an epidemic typhus in it previous to 
1779 ^ Eighty persons had died of that fever in one year, and 

^ Percival, " Population of Manchester." Phil. Trans, hxiv. 54.. 
- James Lucas, "Remarks on Febrile Contagion." London Medical yoiirnnl, 
X. -260. 



Typhus ill Leeds and Carlisle, 1779-81, 147 

many who struggled through the disease died afterwards of 
lingering complaints. In two courts or yards (such as might 
have been the Lantern Yard which Silas Marner found pulled 
down when he revisited Leeds) forty persons were affected with 
the fever ; some families had received ten shillings a week from 
the assessment for the poor. As early as 1779 Lucas proposed 
a house of reception for contagious fever, a proposal which was 
carried into effect in 1804, after a whole generation of typhus 
and at a time when there was little fever in Leeds or elsewhere, 
The infectious fevers, being chiefly confined to the poor, often 
prevailed, says this writer, for a length of time without exciting 
much alarm, or without their fatality being attended to ; but, he 
adds about the year 1790, "should a few of the higher rank 
receive the infection, then the disease is described in most 
exaggerated terms." 

Carlisle was a good instance of the increase of urban 
population and the breeding of typhus. In seventeen years, 
from 1763 to 1780, the inhabitants had increased from 4158 to 
6229, many of the immigrants being Scots and Irish with their 
families. The chief industry was the making of calico, in which 
the women and children were employed as well as the men. 
When Dr Heysham surveyed the town and suburbs for his 
census of 1779, he had "opportunity of seeing many scenes of 
poverty and filth and nastiness ^ " ; and in the bill of mortality 
for that year he confesses himself astonished that there should 
be so little fever. 

The great outburst of typhus at Carlisle began in the end of 
March, 1781, with no very obvious special provocation^. Up- 
wards of 600 had typhus to February 7th, 1782, at which date 
12 or 15 were still suffering from it. The deaths were less than 
I in 10 of all attacked : viz. 2 in May, 4 in June, 8 in July, 8 in 
August, 7 in September, 9 in October, 8 in November, 6 in 
December, and 3 in January, 1782, a total of 55. Of this 
total of fatal cases, 3 were boys, 4 bachelors, and 1 5 husbands : 
3 girls, 2 maids, 22 wives, and 6 widows. Two-thirds of all the 
deaths were of married people; Heysham saw no case in a child 
under three years. It affected about a tenth part of the inhabit- 

^ In Appendix to Hutchinson's Ctmtbei'land, 1794. Reprinted in Appendix to 
Joshua Milne's Valuation of Annuities, 'Lond.. 1815. 

^ John Heysham, M.D., Account of the Jail Fever, or Typlms Carcerjim, as it 
appeared at Carlisle in 1781. London, 1782. 

10-^2 



148 Typhus mid other Continued Fevers. 

ants of Carlisle (6299), and raged most among the lower class 
who lived in narrow, close, confined lanes and in small crowded 
apartments, of which there were a great many in Carlisle, 
generally going through all the inmates of a house where it had 
once begun. On seeking to trace the origin of the epidemic, he 
found that it began in the end of March, 1 781, in a house in 
Richard-gate, which contained about half-a-dozen very poor 
families. Every window that could be spared was shut up, to 
save the window-tax. The surgeon who attended some of these 
poor wretches told Dr Heysham that the smell was so offensive 
that it was with difficulty he could stay in the house. One 
of the typhus patients in this house was a weaver, who, on his 
recovery, went to the large workshop where he worked, and 
there, it was supposed, gave the infection (in his clothes) to his 
fellow workmen, by whom new centres of infection were made 
in various other houses. In August, a young man just recovered 
from the fever went to his mother's in the small village of 
Rockliffe, four or five miles from Carlisle, to get back his 
strength in the country air ; his mother soon took the fever and 
died, and a neighbour woman who came to her in her sickness 
likewise caught it and died. These were all the cases known in 
the village, and they show the enormously greater fatality of 
typhus in those not inured to its atmosphere and conditions. 

The state of population and health at Warrington was 
peculiar, and is given fully in another chapter. There could 
be no more striking instance of the growth of what the foreign 
writers call the proletariat ; an old market-town, with a small 
sail-cloth industry from Elizabethan times, it became a busy 
weaving town owing to the demand for sail-cloth during the war 
with the American colonies. The whole population of some 
9000 men, women and children, were wage-earners ; the women 
were all the while unusually prolific, and the sacrifice of infant 
life was enormous, especially by smallpox. We have no 
particular accounts of fevers ; but in the bill of mortality for 
1773, the year of a disastrous smallpox epidemic, there were 
25 deaths from fever, of which 10 were of " worm fever," or the 
remittent of children ^ 

By the year 1790, when Ferriar's accounts of fever in 
Manchester begin, the industrial revolution had been accom- 
plished, mills were everywhere, and the characteristic hardships 

^ Aikin, Phil. 7'raiis. I. XIV. 473. 



TypJuis in Manchester, 1790. 



149 



and maladies of a prolific working class in a time of slack trade 
were already much the same as we find them pictured with 
fidelity and pathos in the pages of Mrs Gaskell half a century 
after. 

But, so as not to exaggerate the ill health of the working 
class in Manchester at the end of the i8th century, let us 
compare the births with the deaths according to the doubtless 
imperfect registers ^r 



Manchester^ Births and Deaths^ 1770-91. 



Year 


Births 


Deaths 


Year 


Births 


Deaths 


1770 


1050 


988 


1781 


159I 


1370 


I77I 


1 169 


993 


1782 


1678 


984 


1772 


II27 


904 


1783 


1615 


1496 


1773 


1 168 


923 


1784 


1958 


1 175 


1774 


1245 


958 


1785 


1942 


1734 


1775 


1359 


835 


1786 


2319 


1282 


1776 


I24I 


1220 


1787 


2256 


I761 


1777 


1513 


864 


1788 


2391 


1637 


1778 


1449 


975 


1789 


2487 


1788 


1779 


1464 


1288 


1790 


2756 


1940 


1780 


1566 


993 


I79I 


2960 


2286 



The mean lodging-houses in the outskirts of the town, says 
Ferriar, in 1790^ were the principal nurseries of febrile 
contagion : some of these were old houses with very small 
rooms, into each of which four or more people were crowded 
to eat, sleep, and frequently to work. They commonly bore 
marks of a long accumulation of filth, and some of them had 
been scarcely free from infection for many years past. As soon 
as one poor creature dies or is driven out of his cell he is 
replaced by another, generally from the country, who soon feels 
in his turn the consequences of breathing infected air. There 
was hardly any ventilation possible, many of these old houses 
being in dark narrow courts or blind alleys. In other parts 
of the town the lodging-houses were new, and not yet thoroughly 
dirty; but in these there was a long garret under the tiles, in 
which eight or ten people often lodged, the beds almost 
touching. Again, many lived in cellars, sleeping on the damp 
floor with few or no bedclothes ; the cellars of Manchester, 
however, were better ventilated than those of Edinburgh, and 

^ John Aikin, M.D., The Country from 30 to 40 miles rojind Manchester. Lond. 
1795. P- 584- 

^ John Ferriar, M.D., Medical Histories and Reflections. 4 vols., 1810-13, i. 172 



150 Typhis and other Continued Fevers. 

freer from fever. These cellar-tenants were subject to the 
constant action of depressing passions of the mind. " I have 
seen patients," says Ferriar, " in agonies of despair on finding 
themselves overwhelmed with filth and abandoned by everyone 
who could do them any service, and after such emotions I have 
seldom found them recover." Addressing the Literary and 
Philosophical Society of Manchester previous to 1792, he 
pointed out in an argnmentnvi ad hominem that " the situation 
of the poor at present is extremely dangerous, and often 
destructive to the middle and higher ranks of society^" And 
again, " the poor are indeed the first sufferers, but the mischief 
does not always rest with them. By secret avenues it reaches 
the most opulent, and severely revenges their neglect or 
insensibility to the wretchedness surrounding theml" 

In an address to the Committee of Police in Manchester, 
he instances the following cases : 

A family of the name of Turner in a dark cellar behind Jackson's Row : 
they have been almost constantly patients of the Infirmary for three years 
past on account of disorders owing to their miserable dwelling. There are 
other instances of the same kind in Bootle Street. 

In Blakely Street, under No. 4, is a range of cellars let out to lodgers, 
which threatens to become a nursery of disease. They consist of four rooms 
communicating with each other, of which the two centre rooms are com- 
pletely dark; the fourth is very ill-lighted and chiefly ventilated through the 
others. They contain four or five beds in each, and are already extra- 
ordinarily dirty. 

In a nest of lodging-houses in Brook's entry near the bottom of Long- 
mill-gate, a very dangerous fever constantly subsists, and has subsisted for a 
considerable number of years. He had known nine patients confined in 
fevers at the same time in one of those houses and crammed into three 
small dirty rooms without the regular attendance of any friend or of a nurse. 
Four of these poor creatures died, absolutely from want of the common 
offices of humanity and from neglect in the administration of their medicines. 
Another set of lodging-houses constantly infected is known by the name of 
the Five Houses, in Newton Street^. 

The fever in Manchester was not always malignant typhus : 
sometimes it had the symptoms and low rate of mortality that 
suggest I'elapsing fever. Thus, in the winter epidemic of 1789- 
90, very prevalent in Manchester and Salford, out of Ferriar's 
first ninety patients only two died ; in some the skin had a 
remarkable, pungent heat, in others there were profuse watery 
sweats ; women were commonly affected with hysterical symp- 
toms during convalescence, which was often tedious*. A certain 

' Ferriar, I. 261. " Ibid. I. ■234. ' Ibid. II. 213-20. 

■* Ibid. 1. 153-6; and n. 57. 



Ferriar's illustrations of fever in Manchester. 151 

number of these cases would run into " a formed typhus," with 
petechiae and all the other signs of malignity ; and in some 
seasons, as in the distressful year 1794, typhus was the usual 
form. Two fatal cases in children, examined after death, had 
peritonitis ; " in the one no marks of the disease were discernible 
within the cavity of the [intestinal] tube ; " in the other, the 
patient was covered with petechiae \ These cases of localized 
inflammation in typhus he compares with Pringle's cases of 
spotted fever complicated with abscess of the brain. 

The years 1792 and 1793 passed, says Ferriar, without any 
extraordinary increase of fever patients, although the noxious 
influences were always present. But in the summer and autumn 
of 1794 "the usual epidemic fever" became very prevalent 
among the poor in some quarters of the town, particularly after 
a bilious colic had raged among all ranks of people. This was 
a time when work was slack ; many workmen enlisted and left 
their families. In November and December 1794, as many as 
156 sent applications to the Infirmary in a week to be visited in 
fever at their homes. 

This was a memorable time of scarcity and distress all over 
the country, the beginning of a twenty-years' period of so-called 
" war-prices," when farmers' profits were so large that they could 
afford to double or treble their rents to the landlords. The history 
of epidemics comes at this point into close contact with the 
economic history, which I shall touch on in the sequel, after 
giving a few more particulars of typhus in England and 
Scotland generally, previous to the outbreak of the war with 
France in 1793. 

Typhus in England and Scotland generally, in the 
end of the i8th century. 

The introduction of machinery and the building of mills 
brought typhus fever to places much less crowded than Leeds, 
or Manchester, or Carlisle. 

Dr David Campbell of Lancaster saw much of typhus in 
that town, and in mill villages near it, in the years 1782, 1783, 
and 1784. In Lancaster town he saw about 500 cases, of which 
168 were in men, with 20 deaths, 236 in women, with 11 deaths, 

1 Ferriar, i. 166-8. 



152 Typhus and other Continued Fevers. 

and 94 in children under fourteen, with 3 deaths. At Backbarrow 
cotton mill, twenty miles from Lancaster, there were 180 cases, 
of which 38 were in men, with 5 deaths, 11 in women, with 2 
deaths, and 131 in children under fourteen, with no deaths^ At 
this mill there was an extremely offensive smell in the rooms, 
which came from the privy ; the doors of the latter, " for 
indispensable reasons in the economy of these works, where so 
many children are employed, always comm^unicate with the 
workrooms." Every care had been taken to keep the air sweet, 
but without effect. The offensive smell was in all the cotton 
mills from the same cause ; and in the Radcliffe mill belonging 
to Mr Peel, the typhus was ascribed to that source, the nuisance 
having been at length got rid of. Both at Backbarrow and 
Radcliffe the houses of the workpeople were new, airy and 
comfortable. In the same years typhus raged with uncommon 
severity at Ulverston and in various parts of Lancashire, where 
cotton-mills had been set up'-^. 

The typhus of Liverpool and Newcastle was reproduced in 
Whitehaven and Cockermouth on a scale proportionate to their 
size. Whitehaven, the port of the Cumberland coal-field, was 
the Newcastle of the west coast, and had a large trade with 
Ireland. Many of the labourers lived in cellars. Brownrigg's 
experiences of typhus fever in it went back to near the middle 
of the 1 8th century. The Whitehaven Dispensary was opened 
in 1783, the occasion for it being thus explained : — 

"Previous to the establishment of dispensaries Whitehaven and Cocker- 
mouth were infested by nervous and putrid fever. Many of their respectable 
inhabitants became its victims; and among the lower class of people it 
prevailed with deplorable malignancy. The present period happily exhibits 
a different picture. Notwithstanding our connection with the metropolis of 
Ireland, and other commercial places, contagion rarely appears; or, when 
accidentally introduced, is readily suppressed^." 

The following is the abstract of " contagious fever cases " from 
the records of the Whitehaven Dispensary from 30 June, 1783, 
to 9 June, 1800*: 

1 This is perhaps the first numerical evidence of the slight fatality of typhus in 
children. A more elaborate proof of the same was given long after by Geary for 
Limerick. An early age-table for Whitehaven is given under Smallpox, infra. 

" David Campbell, M.D., Observations on the Typhus or Loiv Contagions Fever. 
Lancaster, 1785. 

* Joshua Dixon, M.D., Annual Reports of the Whitehaven Dispensary, 1795 to 
1805. Details for 1773-4 i" ^''i'^ "ote in Memoirs of Lettsoiii, iii. 353. 

* Dixon, Literary Life of Dr Brozonrigg, pp. 238-9. 



Prevalence of Fever at Whitehaven, &c. 153 



Year 


Cured 


Dead 


Total 


1783 


75 


I 


76 


1784 


401 


9 


410 


1785 


350 


20 


370 


1786 


91 


6 


97 


1787 


21 


I 


22 


1788 


53 


7 


60 


1789 


103 


2 


105 


1790 


288 


21 


309 


I79I 


74, 


6 


79 



Year 


Cured 


Dead 


Total 


1792 


17 


2 


19 


1793 


7 


3 


10 


1794 


13 


I 


14 


1795 


28 


2 


30 


1796 


48 


I 


49 


1797 


35 


2 


37 


1798 


12 


I 


13 


1799 


II 


I 


12 



Total 1627 85 17 1 2 
The year 1790 is indicated as an unhealthy one, by the excess 
of burials over christenings, also at Macclesfield, where there 
were 316 christenings to 380 burials, the proportion being 
usually the other way\ 

Dr John Alderson of Hull wrote in 1788 an essay on the 
contagion of fever, in which there are no authentic details for 
Hull : " The calamity itself is the constant complaint of every 
neighbourhood, and almost every newspaper presents us with an 
example of the direful consequences of infection " — the reference 
being to gaols more particularly ^ Whatever was the reason, 
there was undoubtedly a great deal of typhus in England in the 
eighties of the eighteenth century. Oxfordshire, Gloucestershire, 
Worcestershire, Wiltshire and Buckinghamshire experienced 
much typhus from 1782 to 1785, although we have few particulars. 
" The remembrance of its ravages at Gloucester, Worcester and 
Marlborough," says Dr Wall of Oxford, " is still fresh in every 
mind, where its virulence proved so peculiarly fatal to the 
medical world." At Aylesbury, Dr Kennedy survived an attack 
of the "contagious fever," to write an account (1785) of the 
epidemic, which he traced to the gaol (the date, be it observed, 
is subsequent to Howard's visitations)^ At Maidstone, also, in 
1785, the gaol fever was the subject of a special account^ 

At Worcester in 1783 the younger Dr Johnstone caught 
typhus while visiting the gaol, which was thereafter rebuilt at 
great expense. A prisoner took it to Droitwich where 14 died'. 

Dr Wall gives clinical details of fifteen cases of typhus 
treated by him in private practice at Oxford in 1785 ; one of his 
patients was an apothecary whose business had exposed him 
very much to the influence of contagion, as he was much 

^ Aikin, Country roitnd Manchester. Lond. 1795, p- 616. 
^ Nature and Origin of the Contagion of Fevers. Hull, 1788. 
^ Accotmtofa Contagious Fever at Aylesbury. Aylesbury, 1785. 
'^ Thomas Day, Some Considerations... on the Contagion in Maidstone Jail, 1785. 
^ See Barnes, in Mem. Lit. Phil. Soc. Manchester, 11. 85. Dr Samuel Parr wrote 
his epitaph in the Cathedral. Also Johnstone sen. to Lettsom, Memoirs, iii. 241. 



154 Typhus and other Continued Fevers. 

employed amongst the poor in the suburbs of the town and 
neighbouring villages and in the House of Industry\" In the 
year 1783-85, much of the epidemic fever was of the nature of 
ague, as described in another chapter. It is not always easy to 
separate it from typhus ; but there is no doubt that both were 
prevalent together. Thus in the parish of Painswick, Gloucester- 
shire, in the spring of 1785 there occurred both "a contagious 
fever" and an "epidemic ague," the latter having left a good many 
persons dropsical and cachectic ^ This had been part of an 
epidemical fever which had raged for some time in the county of 
Gloucestershire, and is said to have lately carried off a great 
number of poor. At Norton, within five miles of Gloucester, 
there lived in two adjoining tenements two families : in one a 
man and his wife and three children, in the other a man and his 
wife, of whom only one remained alive on the ist of March, 1785^. 
The extraordinary failure of the harvest in Scotland in 1782 
produced much distress, and with it fever, in the winter following. 
The Glasgow and Edinburgh municipalities imported grain for 
the public benefit. Various traces of the scarcity and fever 
appear in the Statistical Account written a few years after. 
Thus, in Holywood parish, Dumfriesshire, some fevers were wont 
to appear in February and March among people of low circum- 
stances living in a narrow valley ; and the unusual mortality in 
the dear year 1782 was owing to an infectious fever in the same 
cottages. In the regular bills of mortality of Torthorwald parish, 
Dumfriesshire, the deaths from "fever" fall in the dear years, 
1782-3, 1785, &c. In Dunscore parish, in the same county, the 
burials of 1782 rose to the most unusual figure of 30 (the 
baptisms being 17), "owing to a malignant feverV 

1 Martin Wall, M.D., Clin. Obs. on the Use of Opium in Low Fevers mid in the 
Synochus. Oxford, 1786. 

^ J. C. Jenner, in Land. Med. Journal, vii. 163. 

^ Gent. Magaz. 1785, i. 231, March i. 

•* This is the period and the district to which Robert Burns refers, under date of 
21 June, 1783, in a letter to his cousin, James Burness, of Montrose: " I shall only 
trouble you with a few particulars relative to the wretched state of this country. Our 
markets are exceedingly high, oatmeal 17^/. and \%d. per boll, and not to be got even 
at that price. We have, indeed, been pretty well supplied with quantities of white 
peas from England and elsewhere ; but that resource is likely to fail us, and what will 
become of us then, particularly the very poorest sort, heaven only knows." The 
lately flourishing silk and carpet weaving had declined during the American War, and 
the seasons had been adverse to farmers. The lines in Burns' poem, " Death and 
Dr Hornbook" : . ^his while ye hae been mony a gate 
At mony a house.' 
' Ay, Ay,' quoth he, and shook his head. — 
arc explained |jy a note, "An epidemical fever was then raging in the country." 



The dearth in Scotland, 1782. 155 

But Scotland was now past the danger of actual famine from 
even a total failure of the harvest. Some farmers were ruined, 
and many more were unable to pay the year's rent ; but the very 
poorest were enabled to find food, one source being "the im- 
portation of white pease from America." From Delting, in 
Shetland, one of the poorest parishes, the report is : " There is 
reason to believe that none died from mere want ; but there is 
no doubt that many, from the unwholesome food, contracted 
diseases that brought them to their graves." 

The following relating to the parishes of Keithhall and 
Kinkell, Aberdeenshire, in the scarcity following the lost harvest 
of 1782, is a curiously detailed glimpse of the time : 

"Several families who would not allow their poverty to be known lived on 
two diets of meal a day. One family wanted food from Friday night till 
Sunday at dinner. On the last Friday of December, 1782, the country 
people could get no meal in Aberdeen, as the citizens were afraid of a 
famine; and a poor man, in this district, could find none in the country the 
day after. But the distress of this family being discovered, they were 
supplied. Next day the [Kirk] session bought at a sale a considerable 
quantity of bere, which was made into meal. This served the poor people 
until the importation at Aberdeen became regular, and every man of 
humanity rejoiced that the danger of famine was removed ^" 

We hear most of fevers in the Highland parishes, with their 
subdivisions of holdings and an excess of population. Thus of 
Gairloch, Ross-shire, it is said : " Fevers are frequent, sometimes 
they are of a favourable kind, at other times they continue long 
and carry off great numbers " — the poor in this parish, upon the 
Kirk Session roll, numbering 84 in the year 1792, and the 
aggregate money paid to the whole number averaging £6. ys. in 
a year, whereas the fertile parish of Ellon, Aberdeenshire, with 
40 on the poor's roll, paid them £/^'^ per annum. 

Again, of the fishing village of Eyemouth, it is said : " The 
only complaints that prove mortal in this place are different 
kinds of fevers and consumptions ; and these are mostly confined 
to the poorest class of people, and ascribed to their scanty diet." 
And of another fishing parish, in Banffshire, Fordyce, including 
Portsoy, it is said : " The most prevalent distemper is a fever, 
and that for the most part not universal, but confined to 
particular districts. It is sometimes thought to arise from 
infection and communication with other parts of the country ; at 
other times from local situations and circumstances of the 
people's houses and habits of living in particular districts^" 

^ Account by Rev, Geo. Skene Keith, Statist. Act. li. 544. - Also Banff, iHd. xx. 347. 



156 TypJuLS and other Continued Fevers. 

The beginning of the great French war was the occasion of a 
considerable increase of fever ; although no records make it 
appear so fatal a time as the years 1783-86. The commercial 
distress and want of work which began in the autumn of 1792, 
were intensified by the bad harvests of 1794 and 1795, which 
followed two harvests also deficient. This was the period of 
distress and of epidemic fever to which Wordsworth referred in 
the passage in the first book of the ' Excursion,' where he is 
relating the story of Margaret's ruined cottage\ 

There is little medical writing upon the epidemic fever of 
1794-95 ; and, in the very district of Wordsworth's story, the 
records of the Whitehaven Dispensary bear no traces of a great 
concourse of patients. There is reason to think that the fever, 
if slow and weakening, was seldom fatal, that it was typhus 
initior, and that it was sometimes, perhaps often, relapsing. One 
glimpse we get of it in the family of the afterwards celebrated 
Dr Edward Jenner of Berkeley, in the winter of 1794-95. He 
thus writes to a friend about the visitation of " grim-visaged 
typhus:" 

"You shall hear the history of our calamities. First fell Henry's [his 
nephew and assistant] wife and sister. From the early use of bark, they 
both appeared to recover; but the former, after going about her ordinary 
business for some days, had a dreadful relapse which nearly destroyed her. 
It was during my attendance on this case that the venomed arrow wounded 
me... Like Mrs Jenner's fever, at an early period there was a clear inter- 

1 " Not twenty years ago, but you I think 

Can scarcely bear it now in mind, there came 
Two blighting seasons, when the fields were left 
With half a harvest. It pleased heaven to add 
A worse affliction in the plague of war, &c." 
Trotter, Mcdicina Naiitica, l. 182, 1797, gives these real cases: — "During the 
short time that I attended the dispensary at Newcastle, just at the beginning of the 
[French] war, I was sent for to a poor man in a miserable and low part of the town 
called Sandgate. He was ill with what is called a spotted fever." Six children were 
standing round his bed, the oldest not more than nine. They had been ill first, then 
his wife, who was recovered and had gone out to pawn the last article they had to 
buy meal for the children. The man worked on the quay at is. 2d. per diem. Again, 
* ' When I practised as a surgeon and apothecary at the end of the late [American] war 
in a small town in Northumberland, with an extensive country business, some 
similar scenes came under my view. Two servants of two opulent farmers applied 
to me for relief. The first had seven children, who took the fever one by one till the 
whole became sick. His wages were is. per diem. His master, a rich man, 
thought himself charitable by allowing them to pull turnips from his field for 
food. The other servant was a shepherd ; but his herding, as the saying is, was 
a poor one. Tlie first and second of six children were able to work a little, till 
they got a fever in a severe winter, and down they fell, one after another, the 
father and mother at last." They wanted to sell the cow; but some charitable ladies 
raised a small suljscription, by whicli means the comforts of wine and diet came 
within their reach; tlieir master, for his part, sent them tlie carcase of a sheep, which 
had been found dead in a furrow, with a request that the skin should be returned. 



Relapsing Fever in 1794. 157 

mission for four days. ..On the eighth day after the first seizure it again set 
in, in good earnest, and continued one-and-twenty days...Dr Parry was with 
me from Bath five times, Dr Hicks and Dr Ludlow as many, and my friend 
George was never absent from my bedside. ..But, to return to that mansion 
of melancholy, Henry's. His infant girl has now the fever; a servant maid in 
the house is dying with it; and to complete this tragical narrative, about 
five days ago fell poor Henry himself. His symptoms at present are such 
as one might expect : violent pain in the head, vertigo, debility, transient 
shiverings....His pulse this evening is sunk from 125 to 100. The stench 
from the poor girl is so great as to fill the house with putrid vapour ; and I 
shall remove him this morning by means of a sedan-chair to a cottage near 
my own house^." 

This is a tolerably clear picture of a short-period fever with 
relapses, or of relapsing fever strictly so-called ; the stench, 
also, of one patient is characteristic. Barker, of Coleshill or 
Birmingham, has much to say under the same year 1794, of 
a slow, tedious fever, marked by " sluggish action and comatose 
symptoms," and much subject to relapses ; but he does not give 
the duration of the first or subsequent paroxysms, as Jenner 
does, or the usual length of the clear intervals, his most definite 
case being of a young woman who died in twenty-four hours 
from a relapse which came on about three weeks after the fever 
had left her^ 

It was the access of fever in 1794-5, and the alarm that it 
caused among the richer classes, that led to the opening of the 
Manchester House of Recovery in 1796. In certain streets in 
the neighbourhood chosen for the hospital, Portland Street, 
Silver Street and others in the same block, the cases of 
contagious fever for nearly three years before the hospital was 
opened are given by Ferriar as follows : 

Sept. 1793 to Sept. 1794, cases of fever, 400 
Sept. 1794 to Sept. 179s, „ „ „ 389 
Sept. 1795 to May 1796, „ „ „ 267 

The cases began to be sent to the hospital on the 27th May, 
1796, and an attempt was made to extinguish contagion in the 
houses, by white-washing, disinfecting and the like ; so that 
in the same group of streets there were only 25 cases of fever 
from 13 July, 1794 to 13 March, 1797. Meanwhile the admis- 
sions to the hospital were few until the dearth of 1799- 1802. 
One of the manufacturing towns which is known to have shared 
in the epidemic fever of 1794-96 was Ashton-under-Lyne, 
where upwards of three hundred cases (with few deaths) 

^ Jenner to Shrapnell, Baron's Lifeofyenner, I. 106-7. 
^ John Barker, Epidetnicks, pp. 201-6. 



158 Typhus and other Continued Fevers. 

occurred in less than three months at the end of 1795. This 
epidemic must have been somewhat special to Ashton, for it 
produced much alarm in neighbouring places and caused 
Ashton to be avoided from fear of infection. 

Shortly after 1796, Ferriar made an inquiry into an epidemic 
of fever at a village within a mile of Manchester ; the houses 
were many of them new, built for the convenience of a large 
cotton mill ; but even the new houses were offensive, with cellars 
occupied by lodgers, and almost every house overcrowded. 
This was the first fever in the village, and it was traced to a 
family who had come from Manchester with infected clothes. 
Stockport about the same time erected a House of Recovery, 
having " the same general causes of fever which render the 
disease so common in Manchester"; and Ferriar adds: "I 
believe there is not a town in the kingdom containing four 
thousand inhabitants which would not be greatly benefited 
by similar establishments." 

The bad harvest of 1794 raised the price of wheat to 55^-. jd. 
on I January, 1795, and the prospect of another short harvest to 
'j'js. 2d. on I July. A famine being threatened, the Government 
caused neutral ships bound to French ports with corn to be 
seized, and brought into English ports, the owners receiving an 
ample profit. Agents were also sent to the Baltic to buy corn. 
By these means the price of wheat, which had risen in August 
to ioSj-. A,d., fell in October to yGs. ()d. Parliament met on the 
29th October, and various measures were taken^ In the spring 

1 The dearth of 1794-95 called forth one notable piece, the 'Thoughts and 
Details on Scarcity,' drawn up by Mr Burke, from his experience in Buckinghamshire, 
originally for the use of Mr Pitt, in November, 1795. Burke takes an optimist line, 
and preaches the economic doctrine oi laissez faire: "After all," he asks, "have we 
not reason to be thankful to the Giver of all good ? In our history, and when ' the 
labourer of England is said to have been once happy,' we find constantly, after certain 
intervals, a period of real famine ; by which a melancholy havock was made among 
the human race. The price of provisions fluctuated dreadfully, demonstrating a 
deficiency very different from the worst failures of the present moment. Never, since 
I have known England, have I known more than a comparative scarcity. The price 
of wheat, taking a number of years together, has had no very considerable fluctuation, 
nor has it risen exceedingly within this twelvemonth. Even now, I do not know of 
one man, woman, or child, that has perished from famine; fewer, if any, I believe, 
than in years of plenty, when such a thing may happen by accident. This is owing to 
a care and superintendence of the poor, far greater than any I remember... Not only 
very few (I have observed that I know of none though I live in a place [Beaconsfield] 
as poor as most) have actually died of want, but we have seen no traces of those 
dreadful exterminating epidemicks, which, in consequence of scanty and unwholesome 
food, in former times not unfrequently wasted whole nations. Let us be saved from 
too much wisdom of our own, and wc shall do tolerably well." The last sentence is 
his favourite principle of " a wise and salutary neglect " on the part of (Jovernmcnt. 



knormoiis rise in the prices of food, 1799- 1802. 159 

of 1796, the climax of distress was reached, wheat being at iooj-. 
per quarter. The harvest of 1796 was abundant and wheat fell 
to 57^. -ijd. The harvests of 1797 and 1798 were not equally- 
good, but they were not altogether bad, and the price of wheat 
kept about 50J. for nearly three years, which were years of 
comparative comfort between the dearth of 1794-96 and the 
dearth of 1799- 1802. 

Fevers in the Dearth of 1799-1802. 

Although Willan chooses the end of the year 1799 ^^ enlarge 
upon the London fever, he does not connect it with the dearth 
that was already beginning to be felt (soup kitchens having 
been opened in various parts of London). The price of wheat, 
which had been steadily about 50J. in 1797 and 1798, rose in 
May, 1799 to 6\s. 8^., after a hard winter which had probably 
injured the autumn-sown corn. The harvest turned out ill, and 
the price of wheat rose in December, 1799, ^^ 94-^- ^f^. Bounties 
were offered on imported foreign grain, but in June, 1800, the 
price was 134^'. ^d., falling in August to 96^-. 2d. on the crops 
promising well. The latter end of harvest proved wet, much of 
the grain being lost, so that the price per quarter of wheat rose 
to I33J". in December. There was much suffering, and some 
rioting. Parliament met on the nth November, 1800, on 
account of the dearth, the opinions of the members being much 
divided as to the causes of the high prices. In March, 1801, 
wheat was at \^6s. 2d. per quarter, beef from \od. to \o\d. per 
pound, mutton \\d. to \2d. per pound. It is to this year, when 
the quartern loaf was at one-and-eightpence, that a comparison 
by Arthur Young belongs, showing the great change in the 
purchasing power of wages\ By the end of summer, 1801, 

^ A labourer at Bury St Edmunds, receiving a weelcly wage of five shillings, was 
able to buy therewith at the old prices : 

Cost of same in 1801 

£ s. d. 



'A bushel of wheat 





16 





A bushel of malt 





9 





5j. \ A pound of butter 





I 





A pound of cheese 








4 


^Tobacco, one penny 








I 




£V 


6 


5 


(Weekly wage in 1801, 95. 
"jParish bonus 6s. 










15 






g II 5 deficiency 



i6o Typhus and other Continued Fevers. 

wheat rose to iSoj., and the quartern loaf was for four weeks 
at \s. \o\d. 

Whatever statistics were then kept of fever-cases, show a 
decided rise in the years 1800 and 1801 : 





Manchester 


Glasgow 




London 




House of 


Royal 


Newcastle 


Bills of 




Recovery 


Infirmary 


Dispensary 


Mortality 


Year 


(fever-cases) 


(fever-cases) 


(fever-cases) 


(fever-deaths) 


1796 


371 


43 


201 


1547 


1797 


339 


83 


65 


1526 


1798 


398 


45 


67 


1754 


1799 


364 


128 


— 


1784 


1800 


747 


104 


— 


2712 


180I 


1070 


63 


425 


2908 


1802 


601 


104 




2201 


1803 


256 


85 


352 


2326 


1804 


184 


97 


255 


1702 


1805 


268 


99 


74 


1307 



The London Fever Hospital was not opened until February, 
1802, a small house in Gray's Inn Lane containing sixteen beds. 
It came at the end of the epidemic, and was in small request 
during the next fifteen years. The same epidemic at Leeds 
was the occasion of opening a House of Recovery there in 1804, 
twenty-five years after Lucas had first called for it. The state 
of affairs in Leeds, which at length moved the richer classes 
to that step, is thus described by Whitaker^ : 

"In the years 1801 and 1802 an alarming epidemic fever spread in Leeds 
and the neighbourhood. The contagion extended so rapidly and proved so 
fatal that some hundreds were affected at the same time, and two medical 
gentlemen, with several nurses, fell victims to the disease... In 1802 whole 
streets were infected house by house ; in one court, of crowded population, 
typhus raged for four months successively." 

One of the Leeds physicians, Dr Thorp, seized the occasion 
to urge the need of a fever hospital, in a pamphlet written 
in 1802, in which he said: 

"In a visit made a few days ago to those abodes of misery, I saw in one 
particular district upwards of twenty-five families ill in contagious fever. In 
some houses two, in others six or seven [families] were confined, many 
of whom appeared to be in extreme danger." The superintendent of the 
sick poor stated to Dr Thorp "that sixty famihes in epidemic fever are 
under his care at this time. New applications are making daily. In some 
families three, in others six or seven, are in the disease. Forty persons in 
fever have applied to him for medical aid within the present week^." 

' Loidis and Eliiide, 1816, p. 85. 

- Thorp, Tract of 1802, ciled by Hunter, ^(j'. Med. Suri^. Joitni. April, 1819, 
P- 239. 



Typhus in rural districts, i6i 

The wonder is that, with the enormous prices of food, things 

were not worse. At the time when provisions were dearest, 

work was slack in several industries. A commercial report 

of I April, 1 80 1, speaks of the trade of Birmingham as very 

distressed, a large proportion of the men being out of work ; 

the ribbon trade of Coventry was deplorable, and the woollen 

trade of Yorkshire still worse. Evidence of epidemic typhus 

in various parts of England came out in connexion with the 

reports on influenza in 1803. Holywell, in Flintshire, with a 

large cotton-making industry, had not been free from a bad 

kind of typhus for two years previous to the influenza of 1803^ 

In Bristol there was a good deal of fever in 1802-3, which found 

its way, through domestic servants, into good houses in Clifton, 

"and proved fatal in some instances I" It is probable that these 

are only samples, the writings on epidemics being singularly 

defective at this period. The following, dated loth April, 1802, 

by a surgeon at Earlsoham, near Framlingham, Suffolk, gives 

us a glimpse of malignant contagious fever in a farm-house : 

"The most prevailing epidemics for the last twelve months have been 
typhus maligna and mitior, scarlatina anginosa, measles, and mumps. Many 
of the former have proved alarmingly fatal in several of our villages, w^hilst 
those of the second class of typhoid fevers have put on the appearance of the 
low nervous kind attended with great prostration of strength, depression of 
spirits, loss of appetite, etc., which frequently continue many weeks before a 
compleat recovery ensues." Five cases, of "the most malignant kind of 
typhus," occurred in a farmer's family : one of the sons, aged eighteen, died 
in a few days with delirium, and black sordes of the mouth, tongue and 
throat ; then the father, two daughters, and another son, took the infection 
but all escaped with their lives. Of four persons who nursed them, one 
caught the fever, and died. Four persons in a neighbouring family, who 
visited them, took infection, of whom two died^. 

There was perhaps nothing very unusual in such instances of 
country fevers at the beginning of the century. The incident 
is exactly in the manner of one that figures prominently in a 
story of Scottish life and customs at the same period, which 
long passed current as a faithful picture and as enforcing a 
much-needed morale 

1 Currie, Med. Phys. yourn. x. 213. ^ Beddoes. 

^ Goodwin, Med. Phys. Jonrn. ix. 509. Cf. Gervis, Med. C/iir. Trans, il. 236. 

* Elizabeth Hamilton, The Cottagers of Glenburnie, Edin. 1808: "The only 

precaution which the good people, who came to see him [the farmer] appeared now to 

think necessary, was carefully to shut the door, which usually stood open... The 

prejudice against fresh air appeared to be universal... The doctor did not think it 

probable that he would live above three days ; but said, the only chance he had was 

I in removing him from that close box in which he was shut up, and admitting as much 

1 air as possible into the apartment... While the farmer yet hovered on the brink of 

f death, his wife and Robert, his second son, were both taken ill... Peter MacGlashan 

c. II. ir 



1 62 



Typhis and other Contimted Fevers. 



Comparative immunity from Fevers during the War 
and high prices of 1803-15. 

From 1803 to 18 16 there was comparatively little fever 
in this country. This was notably the case in London, but it 
was also true of all the larger towns where fever-hospitals had 
been established, and it was as true of Ireland as of England. 
This was, indeed, a time of great prosperity, which reached 
to all classes, the permanent rise of wages having more than 
balanced the increased cost of the necessaries of life. The 
following prices of wheat will show that a dear loaf did not 
necessarily mean distress while the war-expenditure lasted : 

Prices of wheat (from Tooke). 





s. 


d. 




s. 


d. 




s. 


d. 


1802 


57 


I 


1810 June 


113 


5 


1817 Sept. 


n 


7 


1803 


52 


3 


Dec. 


94 


7 


1818 Dec. 


78 


10 


1804 Lady Day 


49 


6 


1811 June 


86 


II 


1819 Aug. 


75 




Dec. 


86 


2 


Nov. 


lOI 


6 


1820 


72 




1805 Aug. 


98 


4 


1812 Aug. 


155 




1821 July 


SI 




Dec. 


74 


5 


Nov. 


113 


6 


Dec. 


50 




1806 


12, 


5 


1813 Aug. 


112 




1822 


42 




1807 Nov. 


66 




Dec. 


73 


6 


1823 Feb. 


40 


8 


1808 May 


1Z 


6 


1814 July 


66 


5 


June 


62 


5 


Dec. 


92 




1815 Dec. 


53 


7 


Oct. 


46 


5 


1809 March 


95 




1816 May 


74 




Dec. 


50 


8 


July 


86 


6 


Dec. 


103 




1824 


^s 




Dec. 


102 


6 


1817 June 


III 


6 









The only years in the period from 1803 to 18 16 in which there 
was some slight increase of fever were about 1811-12. There 
was undoubtedly some distress in the manufacturing districts 
at that time, owing to the much talked-of Orders in Council, 
which had the effect of closing American markets to British 
manufactures ^ 

had taken to his bed on going home and was now dangerously ill of the fever... All 
the village indeed offered their services ; and Mrs Mason, though she blamed the 
thoughtless custom of crowding into a sick room, could not but admire the kindness 
and good nature with which all the neighbours seemed to participate in the distress of 
this afflicted family." 

^ Charlotte Bronte's story of Shirley falls in this period and turns upon the 
industrial crisis in Yorkshire ; but it is on the whole a happy idyllic picture. Harriet 
Martineau wrote in Household Words, vol. i. 1850, Nos. 9-12, a story entitled "The 
Sickness and Health of the People of Bleaburn," a Yorkshire village supposed to have 
been Osmotherly. It is, in substance, an account of a terrible epidemic of fever in 
the year 181 1, the story opening with the news of the victory of Albuera and the 
rejoicings thereon. It appears to have been constructed very closely from the real 
events of the plague of 1665-66 in the village of Eyam, in the North Peak of Derby- 
shire, and had probably a very slender foundation in any facts of fever in Yorkshire or 
elsewhere in the year 181 1. "Ten or eleven corpses," says the novelist, "were 
actually lying unburied, infecting half-a-dozen cottages from this cause." Cf. infra, 
Leyinirn, p. J67. 



Decline of fevers in London, 1804-16. 163 

The small amount of fever in London between the year 1803 
and the beginning of the epidemic of 18 17-19 rests on the 
testimony of Bateman^, who in 1804 took up Willan's task of 
keeping a systematic record of the cases at the Carey Street 
Dispensary. He has only two special entries relating to 
typhus: one in the autumn of 181 1, when some cases occurred 
in the uncleanly parts of Clerkenwell and St Luke's ( " but I 
have not learned that it has existed in any other districts of 
London"); the other in October and November 1813, when 
there was more typhus among the Irish in some of the filthy 
courts of Saffron Hill, near Hatton Garden, than for several 
years past, the infection having spread rapidly and fatally in 
several houses. The best evidence of this lull in typhus in 
London is the almost empty state of the new fever-hospital : 



Year 


Admissions 


1802 


164 


1803 


176 


1804 


80 


1805 


66 


1806 


93 


1807 


63 


1808 


69 


1 809 


29 



Year 


Admissions 


1810 


52 


181I 


43 


1812 


61 


1813 


85 


1814 


59 


1815 


80 


1816 


118 


1817 


760 



Until it was removed to Pancras Road, in September, 18 16, 
the London fever-hospital had only sixteen beds. But Bateman 
says that no one was refused admission, and that for several 
years the house was frequently empty three or four weeks 
together. Also at the Dispensary, in Carey Street, he had 
an opportunity during the period 1804-18 16, 

" Of observing the entire freedom from fevers enjoyed by the inhabitants 
of the numerous crowded courts and alleys within the extensive district 
comprehended in our visits from that charity." And again, writing in the 
winter of 1814-15, Bateman says: "To those who recollect the numerous 
cases of typhoid fevers [this term did not then mean enteric] which called 
for the relief of dispensaries twelve or fourteen years ago, and the contagion 
of which was often with great difficulty eradicated from the apartments 
where it raged, and even seized the same individuals again and again when 
they escaped its fatal influences, the great freedom from these fevers which 
now exists, even in the most close and filthy alleys in London, is the ground 
of some surprise." And once more, in the summer of 18 16, just as the new 
epidemic period was about to begin, he says: "The extraordinary dis- 
appearance of contagious fever from every part of this crowded metropolis 
during the long period comprehended by these Reports [since 1804], cannot 
fail to have attracted the attention of the reader." 

^ T. Bateman, M.D., Reports on the Diseases of London... fro?n 1804 to 1816. 
iLond. 1819. 

1 1 — 2' 



1 64 



Typhus and other Continued Fevers. 



Bateman concluded, not without reason, that this immunity 
of London from fever was due to the high degree of well-being 
among the poorer classes in times of plenty ; and although 
he made out that the poor of Dublin, Cork and some Scotch 
towns did not profit by times of plenty so much as those in 
London, yet his reason for the abeyance of fever from 1804 
to 1 8 16 applied to England, Ireland and Scotland at large, and 
was doubtless the true reason. 

The following figures from Manchester^ Leeds^ and Glasgow^ 
hospitals, as well as the Irish statistics elsewhere given, are 
closely parallel with those of London : 

Manchester House of Recovery. 



Year 


Cases 


Deaths 


Year 


Cases 


Deaths 


1796-7 


371 


40 


1807-8 


208 


15 


I797-B 


339 


16 


1808-9 


260 


21 


1798-9 


398 


27 


1809-10 


278 


30 


I 799-1 800 


364 


41 


1810-II 


172 


15 


I 800- I 


747 


63 


181I-I2 


140 


18 


180I-2 


1070 


84 


1812-I3 


126 


13 


1802-3 


60 r 


53 


1813-I4 


226 


17 


1803-4 


256 


33 


1814-I5 


379 


29 


1 804-5 


184 


34 


1815-16 


185 


14 


1805-6 


268 


29 


1816-I7 


172 


6 


1806-7 


311 


33 










Leeds House of Recovery. 






Year 


Cases 


Deaths 


Year 


Cases 


Deaths 


1804 (2 mo 


) 10 





1812 


80 


12 


1805 


66 


6 


1813 


137 


II 


1806 


IS 


2 


1814 


79 


4 


1807 


35 


I 


1815 


146 


IS 


1808 


80 


3 


1816 


121 


13 


1809 


93 


8 


1817 


178 


8 


1810 


75 


14 


1818 (lomo.) 


254 


20 


iSn 


92 


4 










Glasgow Royal Infirmary {Fever Wards). 




Year 


Cases 




Year 


Cases 




179s 


18 




1807 


25 




1796 


43 




1808 


27 




1797 


83 




1809 


76 




1798 


45 




1810 


82 




1799 


128 




181I 


45 




1800 


104 




1812 


16 




1801 


63 




1813 


35 




1802 


104 




1814 


90 




1803 


85 




1815 


230 




1804 


97 




1816 


399 




1805 


99 




1817 


714 




1806 


75 




1818 


1371 





^ Pari. Committee's Report on Contag, Fev. 1818, p. 33. Table by P. M. Roget. 

^ Adam Hunter, Ed. Med. .Surg, jfotirn., April, 1819. 

^ Cleland, Glasgow and Clydesdale Statist. Soc. Transactions, Pt. I. Nov. 2, 1836. 



i 



Probable cases of Enteric Fever, 1804-8. 165 

Even such fever as there was in Britain from 1804 to 1817 
was not all certainly typhus. The high death-rates at the 
Manchester fever-hospital in 1804 and 1805 (i death in 7-5 cases 
and I death in 5*25 cases) may mean a certain proportion of 
enteric cases in those years. "From 1804 to 1805," says Ferriar, 
" many cases were admitted of a most lingering and dangerous 
kind..., Many deaths took place from sudden changes in the 
state of the fever, contrary to the usual course of the disease, 
and only imputable to the peculiar character of the epidemic. 
Similar cases occurred at that time in private practice." Next 
year, 1806, there was an epidemic among the troops at Deal, 
described under the name of " remittent fever," which Murchison 
claims to have been enteric^ In September, 1808, says Bate- 
man, several were admitted into the London House of Recovery, 
with malignant symptoms ; " and some severe and even fatal 
instances occurred in individuals in respectable rank in life." 
He still uses the name of typhus ; but he is aware that the cases 
of continued fever, especially in the summer and autumn of 
1 8 10, had often symptoms pointing to a bowel-fever rather than 
to a head-fever^ 

The years 1807 and 1808 appear to have been the most 
generally unwholesome during this period of comparative im- 
munity from fever ; they were marked by the occurrence of 
dysenteries, agues, and infantile remittents, as well as of fevers of 
the " typhus " kind. The chief account comes from Nottingham I 
The cases of " typhus " there were very tedious, but not violent, 
nor attended with any unfavourable symptoms, only one case 
having petechiae, and all having diarrhoea. The following 

^ Sutton, Account of a Remittent Fever among the Troops in this Climate. 
Canterbury, 1806. 

^ In the first three months of 181 1 a singular fever occurred among working 
people in part of a suburb of Paisley, one practitioner having 32 cases in 13 families. 
It was marked by rigors at the onset, pain in the back, headache, dry skin, loaded very 
red tongue, quick fluttering pulse, watchfulness, delirium-like fatuity, abdominal pain 
in many, foetid stools, great prostration, gradual recovery after fifteen or sixteen days 
without manifest crisis, and relapses in some. In this fever Murchison discovers 
enteric or typhoid. Its limitation to a part of one of the suburbs of Paisley is, of 
course, in the manner of enteric fever ; on the other hand, only one of those 32 cases 
died, which is a rate of fatality perhaps not unparalleled in typhoid but much more 
often matched in typhus or relapsing fever of young and old together; while the 
length of the fever, fifteen or sixteen days or sometimes more, is too great for the 
abortive kind of enteric and too little for enteric fever completing both its first and 
second stages. James Muir, Edin. Med. and Surg. Joiirn. viii. 134. Murchison, 
Continued Fevers, p. 428. 

^ James Clarke, M.D., "Medical Report for Nottingham from March 1807 to 
March 1808," Edin. Med. and Surg, yourn. IV. 422. His account of the unwhole- 
some state of the weavers' houses is as bad as any of those already given. 



1 66 Typhus and other Continued Fevers. 

table of admissions for various kinds of fever (as classified by 
Cullen) at the Nottingham General Hospital, 25 March, 1807, 
to 25 March, 1808, shows the preponderance of "synochus" and 
next to it, of infantile remittent : 



Admitted to the Nottingham 


General 


Hospital^ 1807. 


Intermittent fever 




7 


Synocha 




10 


Typhus 




27 


Febris nervosa 




26 


Synochus 




15s 


Febris infantum remittens 


88 


Dysentery 




5 



The state of war in the Peninsula was favourable to 
epidemic or spreading diseases, and there is a good deal to show 
that such diseases did exist among the British troops^ But 
there is only one good instance of England getting a taste of 
that experience of war-typhus which the Continent had to 
endure for many years. This was on the return of the remnant 
of the army after the defeat at Corunna on 16 January, 1809. 
The troops were crowded pell-mell on board transports, which 
had a very rough passage home. Dysentery broke out among 
them, and was the most urgent malady when they landed at 
Plymouth in a state of filth and rags. Typhus fever followed, 
but in the first three weeks at Plymouth, to the i8th of February, 
it was not of a malignant type, only 8 dying of it in the Old 
Cumberland Square Hospital ; in the next three weeks, 28 died 
of it there. Up to the 27th of March, 1809, the sick at Plymouth 
from the Corunna army numbered 2432, of whom 241 died. 
Of 4 medical officers, 3 took the contagion, of 29 orderlies, 
25 took it. The fever was in some cases followed by a relapse, 
which was more often fatal than the original attack ^ This 
was a typical instance of typhus bred from dysentery or other 
incidents of campaigning, a contagion more dangerous to others 
than to those who had engendered it. " Within a few yards of 
the spot where I now write," says Dr James Johnson, of Spring 
Gardens, London, "the greater part of a family fell sacrifices 
to the effects of fomites that lurked in a blanket purchased 
from one of these soldiers after their return from Corunna^" In 

' McGrigor, "Med. Hist, of British Armies in Peninsula," Med. CJiir. Trans, vi. 
381. 

^ Richard Hooper, "Account of the Sick landed from Corunna," Ediii. Med. and 
Surg, Journ. V. (1809), p. 398. See also Sir James McGrigor, ibid. vi. 19. 

^ James Johnson, Injluence of Tropical Climates, p. 20. 



Typhus of the Napoleonic Wars. 167 

August, 18 1 3, an Irish regiment passing through Leyburn, 
a small market-town of the West Riding of Yorkshire, in an 
airy situation, was obliged to leave behind a soldier ill of 
typhus, who died of the fever after a few days. The infection 
appeared soon after in the cottages adjoining, and remained 
in that end of the town for several months, choosing the clean 
and respectable houses. In a farmer's family, a son, aged 
twenty-nine, died of it, while another son and two daughters 
had a narrow escape. The disease appeared also in the village 
of Wensby, a mile distant, and in other villages. Few lives 
were lost\ 

These were, perhaps, not altogether solitary instances in 
Britain of typhus spread abroad by the movements of troops 
during the great French war. Let us multiply such instances 
by hundreds, and we shall vaguely realize the meaning of the 
statement that the period of the Napoleonic wars, and more 
particularly the period from the renewal of the war in 1803 
until its close in 181 5, was one of the worst times of epidemic 
typhus in the history of modern Europe. It was precisely in 
those years that England, Scotland and Ireland enjoyed a most 
remarkable degree of freedom from contagious fever. 

The Distress and Epidemic Fever (Relapsing) following 
the Peace of 1815 and the fall of wages. 

The long period of comparative immunity from typhus near 
the beginning of the 19th century was first broken, both" in 
Great Britain and in Ireland, by the very severe winter of 
1 8 14-15 ; but it was not until the great depression of trade 
following the peace of 18 15 (which made a difference of forty 
millions sterling a year in the public expenditure) and the 
bad harvest of 18 16 that typhus fever and relapsing fever 
became truly epidemic, chiefly in Ireland but also in Scotland 
and England. The lesson of the history is unmistakable : 
with all the inducements to typhus from neglect of sanitation in 
the midst of rapidly increasing numbers, there was surprisingly 
little of the disease so long as trade was brisk and the means of 
subsistence abundant. The reckoning came in the thirty years 
following the Peace. 

^ J. Terry, in Ed. Med. and Surg. Journ., Jan. 1S20, p. 247. 



1 68 Typhiis and other Continued Fevers. 

In London, says Bateman^ the epidemic began in the 
autumn of 1816, before the influence of scarcity was acutely 
felt, in the courts about Saffron Hill, the same locality in which 
he mentioned fever in the winter of 1813-14 among the poor 
Irish. But this means little more than that the Irish, whether 
in Ireland or out of it, are the first to feel the effects of scarcity 
in producing fever. At the very same time that it began among 
them in Saffron Hill, it began among some young people at 
a silk factory in Spitalfields. In March, 18 17, there was a good 
deal more of it in Saffron Hill, as well as among the silk-weavers 
in Essex Street, Whitechapel, in Old Street, in Clerkenwell, 
and in Shadwell workhouse. Many poor-houses, and especially 
those of Whitechapel, St Luke's, St Sepulchre's and St George's, 
South wark, were getting crowded in 18 17 with half-starved 
persons, among whom fever was rife in the summer and autumn. 
There was also much of it in the homes of working people in 
the eastern, north-eastern and Southwark parishes, with more 
occasional infected households in Shoe Lane, Clare Market, 
Somers Town and St Giles's in the Fields ("in the filthy streets 
between Dyot Street and the end of Oxford Street ")\ The 
hospitals and dispensaries were fully occupied with fever, and 
the new House of Recovery in Pancras Road, with accommodation 
for seventy patients, was soon full. At the Guardian Asylum 
for young women, more than half of the forty inmates were 
seized with the fever in one week. The cases were on the 
whole milder than in ordinary years ; of 678 admitted to the 
House of Recovery in 18 17, fifty died or i in 13*5. In two- 
thirds of these patients the fever lasted two weeks or to the 
beginning of the third week ; of the remaining third, a few 
lost the fever on the 7th, 8th or 9th day, a larger number on the 
1 2th to the 14th day, while a considerable number kept it to the 
end of the third week or beginning of the fourth. Of the whole 
678, only 75 had a free perspiration, and in only 19 of these was 
the perspiration critical so as to end the fever abruptly. The 
fever relapsed in 54 of the 678, a proportion of relapsing cases 
which seemed to Bateman to be "remarkably great V In most 

^ Bateman, Account of the Contagious Fever of this Country, Lond. 1818. 

^ The following from the " Observations on Prevailing Diseases," Oct. — Nov., 
1818 (perhaps by Dr Copland), in the London Medical Repository, x. 525, shows that 
the relapses in the earlier part of this epidemic had been commonly remarked in 
London: "Fevers are still prevalent... Relapses have been noticed as of frequent 
occurrence in the instances of the late epidemic. To what are these to be attributed? 



The epidemic of i8 17-19 in London. 169 

the symptoms continued without break throughout the illness. 
Besides other febrile symptoms, there were pains in the limbs 
and back, aching of the bones, and soreness of the flesh, as 
if the patients had been beaten. There was a certain proportion 
of severe complicated cases of typhus. Bateman held that the 
differences in type depended on the differences of constitution, 
giving the following reason for and illustration of his opinion : 

"Thus, in the instance of a man and his wife who were brought to 
the House of Recovery together, the former was affected with the mildest 
symptoms of fever, which scarcely confined him to bed, and terminated in a 
speedy convalescence ; while his wife was lying in a state of stupor, covered 
with petechiae and vibices; in a word, exhibiting the most formidable 
symptoms of the worst form of typhus. Yet these extreme degrees of the 
disease manifestly originated from the same cause ; and it would be equally 
unphilosophical to account them different kinds of fever and give them 
distinct generic appellations as in the case of the benign and confluent 
smallpox, which are generated in like manner from one contagion." Besides 
this woman, only eight others had petechiae. 

The House of Commons Committee were unable to find out 
with numerical precision how much more prevalent the fever 
was in 1817-18 than in the years preceding^ To their surprise 
they found that in six of the general hospitals of London, which 
admitted cases of fever, " no register is kept in the hospital to 
distinguish the different varieties of disease." The apothecary 
of St Luke's Workhouse told them that he attended, on an 
average of common years, about 150 cases of fever; in the last 
year [1817] the number rose to 600; and they were assured by 
several besides Bateman, that the great decrease of the deaths 
from " fever " in the London bills of mortality during a space of 
fourteen years at the beginning of the century (1803-17), was 
not a mere apparent decrease, from the growing inadequacy of 
the bills, but was a real decrease. 

The epidemic which began in 1817 continued in London 
throughout the years 1818 and 18 19, chiefly in the densely 
populated poorer quarters of the town. Two instances of the 
London slums of the time came to light before the House 

Are we to ascribe them to the influence of the atmosphere, to anything in the nature 
of the disorders themselves, or to the vigorous plans of treatment which are adopted 
for their removal? These relapses are more common in hospital than in private 
practice... It has recently become the fashion to consider the state of recovery from 
fever as one which will do better without than with the interposition of the cinchona 
bark. Has the prevalence of this negative practice anything to do with the admitted 

[ fact of frequent relapse ? " 

I ^ Report of the Select Cojnmittee of the House of Commons on Contagious Fever, 
Pari. Papers, 1818. 



I/O Typhis and other Continued Fevers. 

of Commons Committee on Mendicity and Vagrancy in 1815- 
16 : firstly, Calmel's Buildings, a small court near Portman 
Square, consisting of twenty- four houses, in which lived seven 
hundred Irish in distress and profligacy, neglected by the parish 
and shunned by everyone from dread of contagion; and, 
secondly, George Yard, Whitechapel, consisting of forty houses, 
in which lived two thousand persons in a similar state of 
wretchedness. The dwellings of the poorer classes in London 
at this period, before the alleys and courts began to- disappear, 
were described thus generally by Dr Clutterbuck^: 

"The houses the poor occupy are often large, and every room has its 
family, from the cellar to the garret. Thirty or forty individuals are thus 
often collected under the same roof ; the different apartments must be 
approached by a common stair, which is rarely washed or cleansed ; there are 
often no windows or openings of any kind backwards ; and the privies are 
not unfrequently within the walls, and emit a loathsome stench that is 
diffused over the whole house. The houses are generally situated in long 
and narrow alleys, with lofty buildings on each side; or in a small and 
confined court, which has but a single opening, and that perhaps a low 
gateway : such a court is in fact little other than a well. These places are 
at the same time the receptacles of all kinds of filth, which is only removed 
by the scavenger at distant and uncertain intervals, and always so im- 
perfectly as to leave the place highly offensive and disgusting." 

In England, generally, this epidemic of 1817-19 is some- 
what casually reported. One writes from Witney, Oxfordshire, 
"on the prevailing epidemic," which began there in July, 1818, 
among poor persons, in crowded, filthy and ill-ventilated situa- 
tions. At first it was like the ordinary contagious fever of this 
country, "a disease familiar to common observation"; but 
afterwards it showed choleraic and pneumonic complications. 
Sometimes the parotid and submaxillary glands were inflamed ; 
petechiae were absent^. The type of fever at Ipswich in the 
spring of 18 17 was contagious (e.g. six cases in one family) and 
sthenic, or of strong reaction, admitting of bloodletting, accord- 
ing to the teaching which Armstrong, Clutterbuck and others 
had been reviving for fevers ^ Those instances, one from. 
Oxfordshire the other from Suffolk, must stand for many. 
Hancock says that the fever of 1817-19 "visited almost every 
town and village of the United Kingdom'*." Prichard says that 

^ On the Epidemic Fever at present prevailing. Lond. 1819, p. 40. 
2 J. B. Sheppard, " Remarks on the prevailing Epidemic." Edin. Med. Surg. 
Journ., July 1819, p. 346. Also for Taplow, Roberts, Lond. Med. Repos. xiv. 186. 

* W. Hamilton, M.D., Med. and Pliys. jota-n., June 1817, p. 451. 

* Latvs and Pficnoviena of Pestilence, Lond. 1821, p. 39. Christison says: "All 
great towns, with the exception it is said of Birmingham." 



The epidemic of i8 17-19 in Yorkshire. 17 1 

it began in Ireland, "where the distress was most urgent, and 
afterwards prevailed through most parts of Britain," some of 
the more opulent also being involved in the calamity. As to 
its prevalence in the manufacturing towns of Yorkshire we have 
ample testimony. The Leeds House of Recovery, which had 
not been fully occupied at any time since its opening in 1804, 
received 178 cases in 18 17, and 254 in the first ten months of 
181 8. Of the latter, 66 came from low lodging-houses, of whom 
upwards of 50 were strangers. Of 50 admitted in January, 
1 8 18, 20 came from four or five lodging-houses in March Lane, 
and from another locality equally bad — Boot and Shoe Yard ; 
while the rest of the 50 in that month came from houses and 
streets in the same vicinity. March Lane was one of the worst 
seats of the great Leeds plague in 1645. By the month of 
April, 1820, the epidemic had decreased a good deal in Leeds, 
the cases becoming at the same time more anomalous \ 
The following is one of the Rochdale cases : 

June 2, 1818, Alice Eccles, a delicate young woman living in a crowded 
and filthy court from which fever had not been absent for nearly a year, was 
bled to ten ounces, purged, and recovered. On September 20th the same 
woman returned, desiring to be bled again. She was labouring under her 
former complaint; " since her last illness she had been repeatedly exposed 
to contagion, or rather, she had been living in an atmosphere thoroughly 
saturated with infectious effluvia, the house in which she resided, and 
generally the room in which she slept, having had one or more cases of fever 
in them," and the windows kept closed^. 

At Halifax in the summer of 1818, typhus (or relapsing 
fever) had increased so much that fever-wards were added to 
the Dispensary. It had been alarmingly fatal in a high-lying 
village near Settle. It was prevalent in Ripon, Huddersfield 
and Wakefield ; and had been brought from Leeds to Atley. 
A Bradford physician visited 27 cases of fever in one day at a 
neighbouring village. Throughout Yorkshire, it was confined 
to the lower orders, and was not very fatal ^ At Carlisle it 
began about July, 1817, and became somewhat frequent in the 
winter and spring following; of 457 cases treated from the 
Dispensary 46 died, or i in lo^ At Newcastle, a mild typhus 
(typhus mitior) broke out in the autumn of 18 16, not in the 
poorer quarters, but mostly among the domestics of good 

1 Adam Hunter, Edm. Med. Surg, yoiirn., Apr. 1819, p. 234, and Apr. 1820. 

^ Wood, "Cases of Typhus." Edin. Med. Sttrg. Journ., April, 1819. 

^ Adam Hunter, u. s. 

•* T. Barnes, Ediii. Med. Surg. Journ.., April, 1S19. 



172 Typhus and other Contimied Fevers. 

houses in elevated situations. There was much privation at 
Newcastle, as elsewhere, at this time, among the poor. Mur- 
chison takes this fever of the autumn of 18 16 at Newcastle to 
have been enteric or typhoid ; but it is described as a simple 
continued fever, with vertigo, headache, and bloodshot eyes, 
lasting from five or six days to four or five weeks, ending 
usually without a marked crisis, and causing few deaths \ The 
epidemic continued in Newcastle for three years, the admissions 
to the Fever Hospital from 4 Sept. 18 18, to 4 March, 18 19, 
having been 160, with 12 deaths. Dr McWhirter wrote, in 
April, 1 8 19, that he saw on his rounds as dispensary physician 
" too many of the obvious causes of fever," including the filth 
and wretchedness of the poor inhabitants : " one rather wonders 
that so many escape it than that some are its victims^" 

Thus far there has been little besides Bateman's essay to 
indicate the nature or type of the fever in England. In Ireland 
it was to a large extent relapsing fever, and, as we shall see, 
it was so also in Scotland. Bateman found less than a tenth 
part of the cases at the London Fever Hospital to have relapses, 
which was an unusually large proportion, in his experience. 
Elsewhere in England the tendency to relapse was either 
wanting or the relapses were described or accounted for in 
other ways ; to understand this it has to be kept in mind that 
the epidemic was the occasion of a great revival of blood-letting, 
a practice which had fallen into disuse in fevers since the last 
half of the i8th century, and was something of a novelty in 
1817. The fever of that year was undoubtedly abrupt in its 
onset, strong, " inflammatory," with full bounding pulse, beating 
carotids, hot and dry skin, intense headache, suffused eyes, and 
the like symptoms, which seemed to call for depletion. The 
common practice was to bleed ad deliquiuin, which meant to 
ten, or fourteen, or twenty ounces, at the outset of the fever. 
There was hardly one of the writers upon the epidemic, unless 
it were Bateman, an advocate of the cordial and supporting 
regimen, who did not consider the stages or duration of the 
fever as artificially determined by the blood-letting, and not as 
belonging to the natural history. 

In order to show how much the treatment by blood-letting 
dominated the view of the fever itself, of its type, its stages, 

^ H. Edmonston, ibid. XIV. (i8r8), p. 71. 
2 T. McWhirler, ibid. April, 1819, p. 317. 



The type of fever at Bristol, 1817-19. 173 

or duration, I shall take the Bristol essay of Prichard, who 
adopted phlebotomy, as he says, at first tentatively and with 
some fear and trembling, but at length practised it vigorously, 
having found it to answer well\ The epidemic of fever in 
Bristol began about June, 181 7, and lasted fully two years. 
The first cases brought to St Peter's Hospital, which was the 
general workhouse of the city, were of wretched vagrants found 
ill by the wayside or abandoned in hovels. About the same 
time forty-two felons in the Bristol Newgate, " one of the most 
loathsome dungeons in Britain, perhaps I might say in Europe," 
were infected, of whom only one died, and he of a relapse. 
From June, 1817, to the end of 18 19, there were 591 cases in the 
poor's house, 647 in the General Infirmary, and 975 treated from 
the Dispensary, making 2213 cases, of which a record was kept. 
But there were also many cases in private practice among the 
domestics, children, and others in good houses, such as those on 
Redcliff Hill. The cases in the poor's house were classified by 
Prichard as follows : 

1817 1818 1819 



Simple Fever 


22 


45 


40 


with cephalic symptoms 


24 


27 


25 


„ pneumonic symptoms 


7 


10 


16 


„ gastric symptoms 


3 


II 


5 


„ enteric symptoms 


3 


4 


5 


„ hepatic symptoms 


5 


3 


3 


exhausted and ) 
moribund ) • 




6 




I 


4 


not characterised 


30 


44 


2 




95 


150 


105 



Of these there died 20 16 11 

The " genuine form," or ground-type, according to Prichard, 
was " simple fever," of which the cases with cephalic symptoms 
were merely the more protracted or more serious. " The pneu- 
monic, hepatic, gastric, enteric and rheumatic forms may be 
regarded as varieties" — the gastric and hepatic being cases 
mostly in summer with jaundice, the enteric in autumn and 
winter with diarrhoea and dysentery. Nearly all these patients 
were bled within four or five days from the commencement of 
the disease : " in a very large proportion of the cases the fever 
was immediately cut short"; when it did not end thus abruptly, 

^ J. C. Prichard, M.D., History of the Epidemic Fever which prevailed in Bristol, 
1817-19. Lond. 1820. 



1/4 Typhus and other ContiiuLed Fevers. 

its symptoms declined gradually, and the attack was over within 
eight or ten days. After the blooding " sleep very frequently 
followed, and a partial or sometimes a complete remission of the 
symptoms." Only one case of relapse is mentioned, No. ii8, 
of the year 1818, and that was a relapse in a very prolonged case: 
the patient was admitted on 6 October, had a relapse on 18 
November, and was discharged on 23 December. Prichard has 
not one word in his text to suggest relapsing fever ; the bulk of 
his cases were simple, continued fever, with or without cephalic 
or other local symptoms, ending in four, six, eight or ten days, 
while some were cases of typhus gravior. The fever was un- 
doubtedly contagious : it spread through whole families, and in 
St Peter's Hospital itself it attacked seventy of the ordinary 
pauper inmates, including a good many lunatics. 

The Epidemic of 1817-19 in Scotland : Relapsing Fever. 

Let us now turn to the epidemic in Scotland, where the 
relapsing type was as marked as in Ireland, if not more so. 
The destitution in the Scots towns in the autumn of 18 16, and 
following years, was fully as great as anywhere in the kingdom, 
although the peasantry of Scotland were not famine-stricken, as 
those of Ireland were. The state of the poorer classes in Edin- 
burgh was graphically set forth in an essay by Dr Yule, in 
i8i8\ and in an article in filackwoods Magazine the year 
after. Vigorous efforts to relieve the distress were made by the 
richer classes, and a special fever-hospital was opened at Queens- 
bery House, the admissions to which, together with the fever- 
cases at the Royal Infirmary, were as follows :^ 

Year Admitted Died Ratio of deaths 

1817 511 T3 I in 15M \ 

1818 1572 75 I in 21 ' 

1819 1027 30 I in 34 
(to I Dec.) 

Of this epidemic several accounts were published at the time, 
including one by Welsh, superintendent of the fever hospital, 
which is dominated, like the Bristol account of Prichard, by 
the idea that blood-letting cut short the fever^ Christison, 

1 Obs. on the Ctire and Prevention of the Contagions Fever now in Edinbzirgh. 
Edin. i8[8. 

2 Edin. Med. Surg. Jozirn. xvi. 146. 

3 Benj. Welsh, Efficacy of Bloodletting in the Epidemic Fever of Edinburgh. 
Edin. 18 1 9. 



TJie epidemic in Scotland, 1817-19. 175 

who had experience of the relapsing form in his own person \ 
describes also two other forms mixed with the cases of relapsing 
fever : a mild typhus, the typhus mitior {typhus gravior being 
exceedingly rare in that epidemic), and a form which began like 
the inflammatory relapsing synocha, and gradually after a week 
put on the characters of mild typhus. 

The admissions for fever to the Glasgow Infirmary, which 
was then the only charity that received fever cases, had been 
at a somewhat low level since the last epidemic in 1 799-1 801. 
They began to rise again with the distress of 18 16 : — 

Admissions for Fever, Glasgow Infirmary. 



Year 


Cases 


1814 


90 


1815 


230 


1816 


399 


1817 


714 


1818 


1371 



Year 


Cases 


1819 


630 


1820 


289 


182I 


234 


1822 


229 


1823 


269 



At the height of the epidemic in 1818 an additional fever 
hospital was opened at Spring Gardens, to which 1929 cases 
were admitted in that and the following year. Great efforts 
were made in Glasgow to " stamp out " the contagion by dis- 
infectants and removal to hospitaP; but the course of the 
epidemic seemed to follow the economic conditions more than 
anything else. 

The outbreak at Aberdeen was later than in the south of 
Scotland, having begun in August, 18 18. The infection was 
said to have been brought to the city by a woman who found 
a lodging in Sinclair's Close. A group of houses in the close, 
covering an area of seventy by fifty feet and containing one 

■^ Life of Sir Robert Christison, Edin. 1885, I. 142: — "I had been scarcely three 
weeks at my post in the fever hospital when I was attacked suddenly — so suddenly, 
that in half-an-hour I was utterly helpless from prostration. I had nearly six days of 
the primary attack, then a week of comfort, repose and feebleness, and next the 
secondary attack, or relapse, for three days more. My pulse rose to i6o, and continued 
hard and incompressible even at that rate. My temperature under the tongue was 
107° t&c." He was bled to 30 oz. and next day to 20 oz. more. Before the end of 
the epidemic, in August, 18 19, he had another attack of relapsing fever, for which he 
was bled to 24 oz. and a third, after exposure to chill, the same autumn, which last 

F was a simple five-days' fever without relapse, also treated by the abstraction of 24 oz. 
of blood. In 1832 he had two attacks of the same synocha without relapses, and 

j throughout the rest of his life many more: e.g. 16 June, 1861, "I have had some- 

j thing like the relapsing fever of my youth " — a five-days' fever with a relapse on the 
i8th day; and again, on 19 March, 1868, "Incomprehensible return of mine ancient 

I enemy." These experiences coloured Christison's view of relapsing fever, the so- 
called relapses being, in his opinion, comparable to the returning paroxysms of ague. 
^ Cleland. 



176 Typhus and other Continued Fevers. 

hundred and three inmates, became the first centre of the fever. 
The scenes described are like those of the Irish epidemics : in 
one room, a man, his wife, and five children were lying ill on 
the floor ; in another, a man, his wife and six children ; in a 
third, a young girl, whose mother had just died of fever, was 
left with three infant brothers or sisters. More than three- 
fourths of the denizens of the close were " confined to bed in 
fever, and all the others crawling about during the intervals 
of their relapses." The value of all the furniture and clothing 
belonging to 103 persons could little exceed £'^. There was a 
horrible stench both within and without the houses (relapsing 
fever being remarkable for its odour). Yet this close was 
usually as healthy as any other part of the town. A House of 
Recovery, with sixty beds, was opened in the Gallowgate, and 
thirty beds were given up to fever-cases in the Infirmary of the 
city. Besides those ninety hospital cases at the date of 17 
December, 18 18, it was estimated that were three hundred more. 
Begging had been put down, so that the contagion had not 
spread to the richer classes. Despite these removals to hospital, 
the epidemic became more general about the New Year, 18 19, 
and of a worse type ; two physicians died of it, and some others 
had a narrow escape. At the outset, the fever had been of the 
relapsing kind — " subject to relapses for a third and fourth 
time, more especially when they return too early to their 
usual labour\" At a later period the epidemic seems to have 
become ordinary typhus, as it did also in Ireland and elsewhere ; 
and it was called typhus in the essay upon it by Dr George 
Kerr^ 

The extent of this epidemic of 1818-19 over Scotland 
generally is not known ; but the following notice of it in a 
country parish of Forfarshire was probably a sample of more 
that might have been given. 

Early in the summer of 1818 an epidemic of continued fever appeared in a 
manufacturing village seven miles from Lintrathen ; it attacked at first 
young and plethoric subjects, and ran through whole families. In August it 
reached Lintrathen parish, in which one practitioner had forty cases, with 
no deaths. The fever was of an inflammatory nature ; the bulk of the cases 
fell in October, and were nearly all of young women. They were bled 
to syncope, which then meant usually to 32 ounces. There was a prejudice 

^ Report signed A. Brebner, provost, printed in Harty, Historic Sketch of the 
Contagious Fever in Ireland, 1817-19. Dublin, 1820, Appendix, p. no. 

^ Meitioir concerning the Typhus Fever in Aberdeen, 1818-19. By George Kerr, 
Aberdeen, 1820. 



Affinities of Relapsing Fever. lyy 

against blooding among the old people, who said "they had had many 
fevers, and in their time no such thing was ever allowed." But, accordino- 
to the doctor, this withholding of the lancet had the effect of protractino- 
their illnesses : "they toasted sick for six weeks, and were often confined 
to bed for months i." 

The epidemic of 1 8 17-19 brought into prominence two 
questions, the one theoretical, the other practical. The theo- 
retical question (not debated at the time) was touching the 
place or afifinities of relapsing fever in the nosology. Christison 
maintained that it was the inflammatory fever, or synocha of 
Cullen, showing a peculiar tendency to relapse. The fever of 
the same epidemic period in. England was also undoubtedly a 
fever of strong or inflammatory reaction, corresponding to Cullen's 
definition of synocha, but it relapsed much less frequently than 
in Ireland and Scotland in the same years. Even in Ireland 
and Scotland there were always many cases of "relapsing fever" 
which did not relapse. The law of its relapses was reduced 
to great simplicity by a physician learned in fevers, Dr John 
O'Brien, in the Dublin epidemic of 1827. The bulk of that 
epidemic was a fever of short periods — three, five, seven or nine 
days, most of the attacks ending on the fifth or seventh night of 
the fever. The attack being ended in a free perspiration, there 
might or might not happen, after an interval, a relapse, and 
again a relapse after that, or even a third. The five-days' fever 
was more liable to relapse than the seven-days' fever, the seven- 
days' fever more liable than the nine-days' fever, the fevers 
of the longest periods not liable at all. In other words, the 
sooner the patient " got the cool," by a night's sweating, the 
more liable he was to have one or more relapses^. 

The logical position of relapsing fever was completed by 
Dr Seaton Reid, of Belfast, when he proposed, in his account of 
the epidemic in 1846-7, to call it Relapsing Synocha^ Other 
fevers have shown a tendency to relapse in certain circumstances. 
Three fevers which have many points in common, the sweating 
sickness, dengue and influenza, are all subject to relapses. It 
was doubtless of the sweating sickness that Sir Thomas More 
was thinking when he wrote : " Considering there is, as physicians 
say, and as we also find, double the peril in the relapse that 

^ William Gourlay, " History of the Epidemic Fever as it appeared in a Country 
Parish in the North of Scotland." Edin. Med. and Surg. Jotirn., July, 1819, p. 329, 
dated 20 Nov. 181 8. 
, 2 Trans. K. and Q. Cat. Phys. Ireland, V. 527. ^ Diib. Q.J. Med. Sc. viii. 297. 

C. II. 12 



178 TypJuts and otJier Contiimed Fevers. 

was in the first sickness." Plague, also, might relapse, or recur 
in an individual once, twice, three times, or oftener in the same 
epidemic season. Enteric is an instance of a long-period fever 
which has at times a tendency to relapses \ None of these, 
however, can dispute the claim of relapsing synocha to be 
relapsing fever par excellence. For whatever reason, the short- 
period fever of times of distress and dearth or famine has shown 
a peculiar tendency to relapse, and has shown that tendency 
more in the 19th century than in the i8th, and more among the 
Irish and Scotch poor than among the English. 

The practical question that carne to the front in the epidemic 
fever of 18 17-19 was that of isolation hospitals for the sick. 
It was thus stated by Dr Millar, of Glasgow, in a letter of advice 
to the authorities of Aberdeen : 

"It is only by a universal, or nearly universal sweep of the sick into 
Fever Hospitals, joined to a universal or nearly universal purification of 
their dwellings, that anything is to be hoped for in the way of suppressing 
our epidemic. So far as this grand object is concerned, all the rest is folly : 
it is worse than folly ^." 

This was the well-meant but somewhat fanatical application 
of a trite and commonplace notion. It was well understood by 
reflective persons at that time, who were quite sound on the 
contagiousness of fever, that the whole question of segregating 
the poor in fever hospitals was beset with difficulties, not merely 
of expense but also of expediency. A Select Committee of the 
House of Commons sat upon it in 1818, and published their 
report, with the minutes of evidence, on the 20th May. So 
much had been said in Parliament by Peel and others, and said 
so truly, of the spreading of fever all over Ireland by whole 
families turned adrift in beggary, that the Select Committee 
were full of ideas of contagion, and of the great opportunity 
of suppressing" fever by destroying its germs or seeds. But they 
had soon occasion to learn that a fever may be potentially 
contagious, yet not contagious in all circumstances, and that 
segregation in fever hospitals had a rival in dispersion through 
general hospitals. Half-a-dozen London physicians of position, 
answering respectively for Guy's, St Thomas's, the London, 
St Bartholomew's, St George's, the Westminster and the 

^ A succession of thirty-one cases of relapsing typhoid at Charing Cross Hospital 
in 1877-78 were made the subject of an able essay by J. Pearson Irvine, M.D., 
Rtdapse of Typhoid Fevjr, London, iS8o. 

''■ Cited in Aberdeen Report, 17 Dec. 18 18, in Marty, App. p. 110. 



Question of special fever hospitals in 1 8 1 8. 1 79 

Middlesex Hospitals, declared that they mixed their cases of 
contagious fever in the ordinary wards annong the other patients; 
and when asked by the astonished Committee whether the fever 
did not spread, they answered one after another with singular 
unanimity, " Never," which under cross-examination, became in 
one or two instances, " hardly ever," as, for example, in the 
evidence for St Thomas's Hospital, where a sister and a nurse 
had caught fever and died. The point of this London evidence 
was that the great safeguard against febrile contagion was free 
dilution with air, and that the great provocation of a contagious 
principle was to "concentrate" the cases of fever^ The Bristol 
experience in the same epidemic, although it did not come 
before the Select Committee, was wholly in agreement with 
medical opinion in London, The fever-cases there were 
received either into St Peter's Hospital, which was the city 
poor-house, or into the General Infirmary. The former was 
an old irregular building, badly ventilated, in which the 
contagion spread freely to the ordinary inmates and became 
very virulent. Contrasting with the apartments of the old 
poor's house, the wards of the Bristol General Infirmary were 
spacious, lofty, well-ventilated : 

"Here the patients labouring under fever were dispersed among invalids 
of almost every other description ; so that, whatever effluvia emanated from 
infected bodies became immediately diluted in the mass of air free from such 
pollution. Here, accordingly, no instance occurred of the propagation of 
fever. None of the nurses were attacked, nor were patients lying in the 
adjacent beds in any instance infected, though cases of the worst descrip- 
tion, some of them exhibiting all the symptoms of typhus gravior, were 
placed promiscuously among the other patients, scarcely two feet of space 
intervening between the beds 2." 

The same practice was kept up in the Edinburgh Infirmary 
until 1858 or longer; Christison, who gives a diagram of an 
ordinary ward with four fever-beds in it, declared in 1850 that 
there had been no spread of fever for fifteen years before, 
except on one occasion, when the rules of the house were 
neglected ^ The bold policy of dispersing fever-patients among 
the healthy was begun by Pringle and Donald Monro during 
the campaigns of 1742-48 and 1761-63 in the Netherlands and 
North Germany. They found that concentration raised the 
contagion to high degrees of virulence and that dispersion 

•^ Report of Select Coinmittee, u. s. p. 6, and minutes of evidence. 

^ Prichard, pp. 74, 88. 

* Christison, Month. J. Med. Sc. x. ; Bennett, Prhicip. and Pract. of Med. 944-5. 

12 5 



i8o Typhus and other Contiiuied Fevers. 

weakened it to the point of non-existence, Monro's success 
at Paderborn in 1761 having been of the most signal kind\ 

The Select Committee of 1818 were more influenced by 
what they were told of the good effects of the earliest Houses 
of Recovery, at Waterford, Manchester and other places in 
the end of the last century. For several years after their 
opening they were little needed, the epidemic which gave the 
immediate impulse to their establishment having subsided in 
due time both in the towns provided with Houses of Recovery 
and in the innumerable places where no such provision had 
been made. The recommendations of the Committee do not 
appear to have been carried out ; for the London Fever 
Hospital, in Pancras Road, which had been enlarged to seventy 
beds when the epidemic began in 18 17, remained the only 
special fever hospital in London until the establishment of the 
hospitals of the Metropolitan Asylums Board in 1870^ 

The confusion of commerce, depression of trade and lack 
of employment which followed the Peace of Paris, and gave 
occasion to the British and Irish epidemic fevers of 1 817-19, 
gradually righted themselves. The price of wheat, which 
would have been still higher after the four-months drought 
of 1818, but for large imports, gradually fell, and was about 
50J-. in 1 82 1, and 40^-. in the winter of 1822-23. After that, 
it rose somewhat again, and the third decade of the century, 
in the middle of which occurred the great speculative crash 
of 1825, was on the whole a hard time for the working classes. 
The history of fever has few illustrations between the epidemic 
of 1817-19 and that of 1826-27, excepting the great famine- 
fever of Connemara and other parts of the West of Ireland 

1 See above, p. iio-ii. 

^ A complementary measure, namely, notification of contagious sickness to the 
authorities, was put in practice at Leeds in 1804 on the opening of the House of 
Recovery there. The Leeds House of Recovery, with fifty beds, was opened on 
I November, 1804, the epidemic of fever being then about over. One of its officers 
was an inspector, whose duty was "to detect the first appearance of infection, to 
cause the removal of the patient to the House of Recovery, and to superintend the 
fumigating and whitewashing of the apartment from which he is removed. So great 
is the solicitude of the physicians to promote early removal that rewards are offered to 
such as shall first give information of an infectious fever in their neighbourhoods." 
It was claimed that this had been a great success, Leeds having been for twelve years 
previous to the epidemic of 18 17 nearly exempted from two of the most infectious and 
fatal diseases, namely, typhus and scarlet fever. (It happened, however, that the 
whole of England, Scotland and even Ireland were exempted to the same remarkable, 
and of course gratifying degree.) Whitaker, Loidis and Eliiiete, 1816, p. 85. 



Year 




1824 


523 


1825 


897 


1826 


926 


1827 


1084* 



Return of Relapsing Fever w 1827. 181 

in 1822, elsewhere described, which coincided with a somewhat 
prosperous time in England and called forth a princely charity ^ 



The Relapsing Fever of 1827-28. 

The epidemic of relapsing fever which was at a height in 
Dublin in 1826, did not culminate in Edinburgh, Glasgow, 
and other towns of Scotland until 1828. It was a somewhat 
close repetition of the epidemic of 1817-19, except that it was 
chiefly an affair of the towns, owing to depression of trade and 
want of work following the great crash of commercial credit 
in 1825-26. In Glasgow, the admissions for fever to the Royal 
Infirmary began to rise in 1825'^ : 

Glasgow: Admissions for Fever. 

Year 

1828 I5II* 

1829 865 

1830 729 

* Some of these were treated at the extra fever-hospital in Spring Gardens. 

At Edinburgh the cases of fever treated in hospital were fewer 
in ordinary years than at Glasgow, but they rose to a higher 
point in the epidemic years^ : 

Edinburgh : Admissions for Fever. 

Year 
1824 
1825 

1826 (nine months) 
1827 

^ A strange epidemic of the early summer of 1824 in a semi-charitable girls' 
school at Cowan Bridge, between Leeds and Kendal, which is the subject of a moving 
chapter in 'Jane Eyre,' was inquired into by Mrs Gaskell, the biographer of Charlotte 
Bronte. Forty girls were attacked with fever. A woman who was sent to nurse the 
sick, saw when she entered the school-room from twelve to fifteen girls lying about, 
some resting their heads on the table, others on the ground ; all heavy-eyed and 
flushed, indifferent and weary, with pains in every limb, the atmosphere of the room 
having a peculiar odour. The symptoms, so far as known, and the circumstances of 
the school, point more to relapsing fever than to typhus, which is the name given to 
it by Charlotte Bronte. None died of the fever (it is otherwise in the tale), but one 
girl died at home of its after-effects. Dr Batty, of Kirby, who was called in, did not 
consider the type of fever to be alarming or dangerous. The dietary of the school 
had undoubtedly been most meagre for growing girls, and its discipline severe. The 
house was old and unsuited for the purposes of a boarding-school. 

^ Cowan, yotirn. Statist. Soc. ill. (1840) p. 271; Glas. Med. yourn. ill. 437. 

^ From the table by Christison, Edin. Med. Joiirn., Jan. 1858, p. 581. 





Year 




177 


1828 


2013 


341 


1829 


771 


456 


1830 


346 


875 







1 82 Typhus and other Continued Fevers. 

Christison gives the following account of the epidemic in 
Edinburgh in 1827-28: 

"Like that of 18 17-19, it arose in Edinburgh during a protracted period 
of want of work and low wages among the labouring classes and trades- 
people ; it prevailed only among the working classes and unemployed poor — 
in the Fountainbridge and West Port districts, the Grassmarket 'closes,' 
the Cowgate and the narrow ' wynds ' descending on either side of the long 
sloping back of the High Street and Canongate." The fever had the same 
three types as in 18 17-19 — many cases of inflammatory, or relapsing, 
or synocha, a few of low fever (typhus), and some between the two — militant 
or inflammatory for a week, then becoming low, and running the continuous 
course of typhus..." The inflammatory fever presented the same extreme 
violence of reaction as in the former epidemic— the same tendency to abrupt 
cessation, with profuse sweating — the same liability to return abruptly a few 
days afterwards — and the same disposition to depart finally in a few days 
more, and again abruptly with free perspiration. The cases of typhus were 
more frequently severe than in 181 8-19. Icteric synocha occurred also 
oftener, although far from frequently 1." 

The epidemic of relapsing fever in 1826-28, which made 
a great impression in the towns of Ireland and Scotland, has 
left few traces in specially English records. But it is clear that 
there was some increase of fever about the same time in 
London ; and it becomes a matter of interest, as well as of 
no little difficulty, to ascertain the type or types of the same. 
It was just after this quasi-epidemic in London that Dr Burne 
published his essay on fevers, the preface bearing the date of 
28th February, 1828 1 The materials of this essay came from 
Guy's Hospital, and they were both clinical and anatomical. 
The author seeks to find a common name for all varieties of 
continued fever, the name that he chooses being " Adynamic 
Fever," " By far the greater number of cases," he says, " are 
of the first or second degree only of severity, and not dangerous." 
These were cases of " simple continued fever," or fever of short 
duration, with flushed face, sufi"used eyes and other signs of the 
" inflammatory " type, or of synocha. Although Burne does not 
give the exact proportion of cases with relapse, as Bateman 
had done for the London epidemic of 18 17-18, yet he makes it 
clear that relapses did occur, and he discusses the phenomenon 
in a manner which makes his testimony interesting : " Con- 
valescents are more liable to a relapse after the adynamic fever 
than after any other disease ; and this may be accounted for 
by the very enfeebled and exhausted state in which the powers 

' Lifd of Cliristison, " Aiitobiogi-apliy." 

* John Burne, M.D., Pract. Treatise on titc Typhus or Adynamic Fever. London, 
1828. 



Relapsing Fever in London, 1827. 183 

of the system are left." His relapses were obviously a return of 
the original fever, beginning again suddenly in the midst of 
convalescence with flushing of the face, headache, dry tongue, 
and scanty urine, and with a great access of febrile heat in the 
night, a disturbance of the system which generally continued 
for several days, while in some it went off sooner with a 
diarrhoea. He assigned three principal causes for the relapse 
— overloading the enfeebled but craving stomach, walking out 
in the open air too soon, and giving way to emotion \ 

The references to relapse apply almost certainly to fevers 
of the shorter periods (synocha or "inflammatory" fever), and 
not to those cases of enteric fever which did undoubtedly occur 
in the practice of Guy's Hospital in the same seasons. 

Typhoid or Enteric Fever in London, 1826. 

The identification of enteric fever and relapsing fever 
respectively, or the separation of each from typhus, became 
actual in Britain at one and the same time. I have already 
said all that seems necessary as to the earlier appearances of 
relapsing fever on the stage of epidemiological history. This 
will be the fitting point in the chronology, the third decade of 
the 19th century, to bring in the question of enteric or typhoid 
fever. As to its identification, or recognition as a distinct 
species, that was not really completed, to the satisfaction of 
everyone, until the elaborate analysis of the symptoms respect- 
ively of typhus and enteric fevers by Sir William Jenner in 
1 849-5 1 "^ But, for ten years before that, the co-existence with 
maculated typhus of a difl"erent long-period fever, having 
abdominal symptoms and abdominal lesion, had been recognised, 

^ To show the effect of emotion m causing a relapse, lie gives an instance, almost 
the only concrete illustration in all his book : An Irishwoman, Ann McCarthy, aged 
26, was admitted to Guy's Hospital on 10 June, 1827, with "adynamic fever of the 
second degree," having been already ill for two weeks: the course of her fever was 
favourable and she was " soon convalescent." While still in the ward mending her 
strength, she lent her bonnet to another female patient to go out with ; finding that 
her kindness had been abused by the woman forgetting to return the bonnet, she 
became exceedingly angry, relapsed into the fever on the loth of July, was wildly 
delirious for several days, and died on the 19th of July. At this time it was the 
practice at Guy's to examine the bodies after death ; but permission was refused in the 
case in question, so that Burne was unable to say " whether the bowels were affected." 
The case, therefore, may have been one of relapsing enteric fever. A similar 
ambiguity is discussed by Hughes Bennett in his Principles and Practice of Physic 
(p. 923), and decided in favour of relapsing fever proper, or relapsing synocha. 

^ Sir William Jenner, M.D., Lcctttres and Essays on Fevers and Diphtheria, 1849 
to 1879. London, 1893. 



184 Typhus and otJier Continued Fevers, 

and the characteristic ulceration or sloughing of the lymph- 
follicles of the ileum, with sphacelation of the mesenteric 
lymph-glands, had been clearly described by several London 
physicians and depicted in coloured plates, in the years 1826 
and 1827, during an unusual prevalence of such cases in London. 
The authentic history of enteric fever in Britain really begins 
with these writings by physicians of St George's and Guy's 
Hospitals. But, as it is improbable that the type of fever was 
absolutely new in the years 1825 and 1826, it may be asked 
whether the enteric type cannot be discovered in the old 
accounts of British fevers, and if so, whether we may assume in 
the past as much enteric fever relatively to spotted typhus, 
relapsing fever, or simple continued fever, as in the period after 
1850. 

Having adverted to this point from time to time in the 
preceding history as it arose, for example in connexion with 
Willis's fever of 1661, Strother's fever of 1727-29, the Rouen 
fever of 1750, and other instances both in children (remittent 
or convulsive or comatose fever of children) and in adults, I 
shall not recapitulate farther back than the beginning of the 
19th century. 

There was a certain amount of post-mortem observation in 
the 1 8th century, especially in camp sicknesses, by Pringle and 
others ; but there is no trace of intestinal ulceration among their 
fatal fevers. It was found, however, in the epidemic of 1806 
among the troops at Deal, and it is probable that Ferriar's 
cases at Manchester about 1804, and Bateman's cases of 
continued fever in London from 1804 to 18 16, were in some 
part enteric, although the anatomical test is wanting. That 
was a period when there was singularly little of the old London 
fever in the houses of the poorer class. Then came the 
remarkable " constitution " of relapsing or simple continued 
fever, from about 18 16 to 1828, the relapsing character of which 
was far more obvious in Ireland and Scotland, than in London, 
Bristol, or elsewhere in England, but was not altogether 
unobserved in London, whether in 18 17-19 or in 1827-28. 
The relapsing type disappeared after that for fifteen or twenty 
years, and was replaced by typhus more maculated than had 
been seen for many years. But, before the relapsing or simple I 
continued fever disappeared for a time, enteric fever was seen 
in London in company with it. 



Enteric Fever in London in 1826. 185 

The chief season of enteric fever in London was the autumn 
of 1826, following a long period of great drought and heat. The 
remarkable weather of that season was the same in England, 
Ireland and Scotland, and is thus described for the last by 
Christison : 

"The spring and summer seasons of that year were remarkable for the 
extraordinary drought and heat which prevailed for many continuous 
months. No such seasons could be recollected by anybody, and assuredly 
there has been nothing similar in this country since.... The fine weather set 
in with the beginning of March, and continued, with scarcely a check, well 
into the autumn.... The drought prevailed and the heat increased till the 
middle of June, when a thunderstorm with heavy rain cooled the air for 
a day or two. But the heat then became greater than ever, and there was 
continuous sunshine and no rain till after the middle of July, when again 
there was thunder and rain, after which sun, heat and drought ruled the 
season once more." The shade temperature at Edinburgh was 84° Fahr., at 
3 p.m. on three successive days of July^. The two summers preceding had 
also been exceptional, that of 1824 having been hot and moist, that of 1825 
hot and dry, with dysentery in Dublin. 

In August, 1826, Dr Cornwallis Hewett, of St George's Hospital, 
published ten fatal cases of enteric fever, four of which had 
occurred in his own practice, six in the practice of his colleagues^ 
The first was admitted on 23 April, 1825, the latest on 3 July, 
1826. While his paper was under hand, he had read in the 
Medico-chirurgical Reviezv for July, 1826, some extracts from 
Bretonneau's paper on " Dothienenterite "'(enteric fever), and he 
pronounced the London cases to be the same as those recently 
observed at Tours. Several other cases occurred at St George's 
Hospital in the autumn of 1826, three of them reported by 
Dr Chambers^. At the very same time, there was a run of 
enteric cases at Guy's Hospital. Dr Bright says: "Fever 
occurred with considerable frequency among the patients who 
presented themselves for admission into Guy's Hospital, during 
the months of October, November and December, 1826. On 
the whole, the disease was not severe." The more comprehensive 
account of these cases was given by Burne, early in 1828, from 
which it appears that the bulk of them were fevers of the shorter 
period, that there were relapsing cases among them, and that 
some were cases of enteric fever, verified by post-mortem 

^ Christison, Life, u. s. i. 341. 

^ " Cases showing the frequency of the occurrence of Follicular Ulceration in the 
Mucous Membrane of the Intestine during the progress of Idiopathic Fever, with 
Dissecdons, and Observations on its Pathology." Loud. Med. and Physical J ourn. y 
Aug. 1826, p. 97. 

3 iiid.^. 351. 



1 86 Typhus and other Continued Fevers. 

examination \ It was the enteric cases that attracted the 
notice of Dr Bright, who says nothing of the relapsing cases, 
or of cases of simple continued fever. The fact that the 
intestinal mucous membrane may become diseased during fever 
was, he says, "long known in particular cases, but never 
suspected to be so general till brought into view by the French 
physicians, and which has lately been illustrated in this country 
with great beauty [this does not mean in plates] by the pens 
of my able and assiduous friends Dr Chambers and Dr Hewett." 
He gives ten fatal cases, with coloured plates of the intestinal 
or mesenteric lesion in some of them, the earliest coloured plate 
having been made from a case admitted on 13 October, 1825, 
and the most typical plate of the sloughing Peyer's follicles from 
a case admitted on 25 November, 1826. He gives also eleven 
cases of recovery, to show the benefit of treating the diarrhoea 
by calomel^ Nearly all the cases occurred in the end of the 
year, either of 1825 or 1826; and Burne confirms this when 
he says that the cases with enteric lesion were found at Guy's 
Hospital only in autumn. Some two years after, in 1830, Drs 
Tweedie and Southwood Smith, physicians to the London 
Fever Hospital, described cases of fever with ulcerated intestine 
and sphacelated mesenteric glands. After that, the interest 
shifted to typhus, which reappeared in London of an unusually 
maculated type; so that the years 1826-30 make a somewhat 
distinct period in which the new fever, with enteric lesion, was 
an engrossing medical topic. It is tolerably certain that it was 
the unusual seasons of 1825 and 1826 which brought enteric 
fever into prominence ; while, as soon as it became frequent, it 
could hardly have escaped the systematic apparatus of clinical 
case-taking and post-mortem examination, with preservation 
and drawing of specimens, for which Guy's Hospital was already 
noted under the influence of Bright and his colleagues, and 
in which the staff of St George's Hospital would appear to have 
been not less competent. Although Dr Hewett, in 1826, 
identified his cases with the dothicncnterite of Bretonneau, yet 
neither he nor Dr Bright took the abdominal ulcerations or 
sloughs as distinctive of a new kind of fever. They regarded 
them rather as a new complication of " idiopathic " typhus fever, 
a " complication " which appealed to them more on the side 

^ Burne, u. s. 

- Richard Bright, M.D., Rcporls of Medical Cases. Fart I., 1827. 



Late appearance of Typhoid in Edinburgh. 187 

of treatment than of systematic nosology; hence the writings 
of both physicians are occupied mainly with the benefit of 
calomel in relieving the congestion of the bowels and in checking 
the diarrhoea. 

It is undoubted that cases of enteric fever in 1826-27 were 
relatively more numerous in London than in Dublin and 
Edinburgh, where the epidemic fever was almost wholly of the 
relapsing type. In Edinburgh, at least, the comparative in- 
frequency of enteric fever for years after it had been recognized 
in Paris, Tours and other French cities, and had been found 
in London as a common autumnal type, can be proved beyond 
cavil. Writing long after of the first epidemic of relapsing fever 
in Edinburgh, Christison said : 

"Of enteric typhus (typhoid fever) we saw nothing then [1817-20], nor 
for many years afterwards. If it might have been overlooked during life, it 
could not have been missed after death. For our dissections were many, 
and, to meet the bias of the day for finding a local anatomical cause for all 
fevers [the doctrine of Broussais], every important organ in the body was 
habitually looked to. Nevertheless we were constantly met with the want of 
morbid appearances anywhere, unless slight signs of vascular congestion in 
various membranous textures be considered such^." 

These vascular congestions were, indeed, scanned closely for 
traces of ulceration, after Bright's plates of 1828, and any little 
irregularity on the surface of a congested Peyer's patch was 
liberally construed in that sense, as in Craigie's reports subse- 
quently. But in the Edinburgh epidemic of 1827-29, the 
anatomical signs of enteric fever were wanting until the end 
of it. Writing in 1827, Alison said that he had dissected 26 
cases dead of the epidemic fever, without finding intestinal 
ulceration in one of them. Christison, however, says that a 
very few cases of enteric fever were dissected in Edinburgh 
in 1829^ 

. ' In Dublin, also, the anatomical mark of enteric fever was 
missed in 1826-27, in the few dissections that were made during 
the epidemic^ An opinion in a widely different sense was 
given on that point by Stokes twelve years after the event, to 
which I refer in a note*. 

^ Life of Sir Robert Christison, i. 144. Also in Trans. Soc. Sc. Assn. 1863, p. 104. 

2 Edin. Med. yotcrn.,]zn. 1858, p. 588. Cf. infra, under Dysentery, 1828. 

^ Raid, Trans. K. and Q. Coll. of Pliys. in Ireland, v. ; O'Brien, ibid. 

* Writing in 1839, Dr Stokes, of Dublin, made the following remarkable assertion 

\ADub. jfoiirn. Med. and Chem. Sc. xv. p. 3, note) : "In the epidemic of 1826 and 

1827 we observed the follicular ulceration (dothienenteritis of the French) in the greater 

number of cases." As the epidemic of 1826-27 was almost wholly one of relapsing 



TypJius and other Continued Fevers. 



Return of Spotted Typhus after 1831 : " Change of Type." 
Distress of the Working Class. 

A fever with relapses, and a fever with sloughing of the 
follicles and lymph glands of the intestine, were not the only 
novelties in the first thirty or forty years of the 19th century. 
Relapsing fever and enteric or typhoid fever were each clearly 
separated, at a later date, from typhus fever. But what was the 
" typhus fever " from which they were at length separated .-* It 
was a fever which came prominently into notice after the " con- 
stitution " of 1826-29 was ended — a fever with a mottled, measly, 
or rubeoloid rash, and with various other spots, on account of 
which it was described by Dr Roupell in 1831, in a lecture 
before the College of Physicians of London, as a " new fever\" 
It was a new fever only in the sense in which each new febrile 
" constitution," whether it were an influenza, an epidemic ague, 
or a malignant typhus, was apt to be called popularly " the new 
fever," in the i6th and 17th centuries. There were, of course, 
erudite men at the College of Physicians in 1831 who knew that 
a fever with a mottled rash, with vibices and petechiae, and with 
all other symptoms of typhus gravior, had often occurred in 
England, Scotland and Ireland in former times. The "spotted 
fever" was perhaps the most familiar name of typhus in the 
17th century. The mottled rash, like that of measles, was 
described for the fever of Cork by Rogers in the beginning of 
the 1 8th century, and for various other English and Irish 
epidemics by Huxham, O'Connell, Rutty and others. But 
undoubtedly the maculated typhus was somewhat new to the 
generation who saw it about 1830 and following years, the 
continued fevers which had prevailed in England, Scotland and 

fever, the statement is at least puzzling. It was made twelve years after the epidemic, 
at a time when the discrepancies between British and French observers, as to the 
occurrence of ulceration of the ileum in continued fever, were much discussed. 
Dr Lombard, of Geneva, having visited Glasgow, Dublin and other places, and 
confirmed the fact that the characteristic lesion of enteric fever was at that time only 
occasional, went on to say that Irish typhus was a species of disease by itself, a 
morbus viiscriae. Whereupon the editor of the ' Dublin Journal of Medical Science' 
(xii. 503, in a review of Cowan's Glasgow Statistics) gave the following truly Irish 
reply: " Mad Dr Lombard made more inquiries, he would have found that Ireland is 
not so sunk in misery and debasement but that she can produce occasionally a fever 
which, in abdominal ulcerations, can compete with the sporadic diseases of her 
weallhicr and more enlightened neighbours." It may have been in the same patriotic 
spirit that Stokes declared " the greater number of cases " in the epidemic of 1826 and 
JS27 lo have had follicular ulceration. 

' G. L. Koupell, M.D., Some Account of a Fever prevalent in 1831. Lond. 1837. 



spotted TyphiLS the common type, 1831-42. 189 

Ireland since 18 16 having been for the most part the simple 
continued, or synocha, with or without the relapsing character, 
and to some extent enteric fever\ 

It was from 1830 to 1834 that a change in the reigning 
type of fever began to be remarked in London, Dublin, Edin- 
burgh and Glasgow, the new type becoming more and more 
evident as fevers became more prevalent in the ' thirties ' and 
'forties.' Typhus at length became so much a spotted fever 
that the question arose whether it should not be classed among 
the exanthemata. In 1840, Dr Charles West, having ob- 
served " the alteration in character which fever has undergone 
within the last few years," went over the history (but more the 
foreign than the English) with a view " to illustrate the question 
whether typhus ought not to be classed among the exanthe- 
matous fevers ^ : " of course he found many old descriptions of a 
mottled rash or other spots, but saw no reason to make spotted 
typhus one of the exanthemata. Dr Kilgour, of Aberdeen, 
who treated more than a thousand cases in his fever-ward at the 
infirmary there from 1838 to 1840, wrote in 1841, " I am per- 
fectly satisfied that this fever, call it by what name we will, is 
truly an exanthematous fever^" Previous to 1835, the spots of 
fever-cases in the Glasgow Infirmary had hardly been remarked; 
but after that date all cases were classed either as spotted or 
not, the spotted cases being three-fourths of the whole. Besides 
being spotted, the fever of the new constitution was insidious in 
its approach and low in its reaction, very unlike the sthenic, 
militant, inflammatory synocha of the generation before. The 
blood-letting which had been all but universally used in the 
fever from 18 16 to 1828, and had seemed to answer well, was 
continued for a time in the fever of the ' thirties.' But it was 
soon found to be injurious: the patients in the new fever were 
apt to faint when only a few ounces of blood (four or six) had 
been drawn, whereas in the other fever (whether relapsing or 

^ In addition to what has been said on tliis point already, for particular epidemics, 
I shall give a statement for ordinary years by Dr Carrick, of Bristol, in his ' Medical 
Topography' of that city: Trans. Prov. Med. Assocti. II. (1834), p. 176. "Continued 
fever is common enough, but nine-tenths of the cases are of a simple character, 
terminating for the most part within seven days, and unaccompanied with anything 
more serious than slight catarrhal or rheumatic disorder. Typhus gravior is rare — 
much more so than might be expected." 

^ Charles West, M.D., "Historical Notices designed to illustrate the question 
whether Typhus ought to be classed among the Exanthematous Fevers." Edin. Med. 
and Surg. Joiirn. 1840, April, p. 279. 

^ Alexander Kilgour, M.D., ibid. Oct. 1841, p. 381. 



190 Typhis and other Continued Fevers. 

simple continued) they had often lost thirty ounces before 
deliquium was reached. It was found, on the other hand, 
that fever-cases in the ' thirties ' needed wine and other cordial 
regimen. There was nothing new in these revolutions, whether 
of the fevers themselves, or of the opinions as to their treatment. 
Sydenham's method of taking his cue for treatment from the 
"constitution" of the season, which was the method of Hippo- 
crates, appeared to be once more the best suited to the circum- 
stances. 

It is not easy to make out what were the circumstances of 
the time that led to the supersession of simple continued fever 
(or relapsing fever in Ireland and Scotland), by spotted fever or 
typhus gravior in all parts of the kingdom. Sydenham would 
have looked, among other things, to the weather and the cha- 
racter of seasons; but from 1830 onwards there was no season 
so notable as the dry and hot summer of 1826, although the end 
of the year 1836 was remarkably wet. The period of typhus 
gravior was a time of much sickness of other kinds — the Asiatic 
cholera of 1831-32, the influenza of 1831, 1833, and 1836-37, 
and the general unhealthiness of the year 1837. This was also 
the decade when the " condition-of-England question " was a 
common topic, a time of strikes and of much distress among the 
working classes, as shown in the reports of the Poor Law 
Commission. 

In Glasgow there was a considerable prevalence of fevers 
year after year from the relapsing-fever epidemic of 1827-29, 
according to the following table of admissions for fever to the 
Royal Infirmary and the special fever-hospitals^ : 

Admissions for Fever, Glasgow. 

Year Fever cases 

1827 1084 

1828 15 I I 

1829 865 

1830 729 

1831 1657 



1832 



1589) 
1148$ 



Year 


Fever cases 


1833 


1288 


1834 


2003 


1835 


1359 


1836 


3125 


1S37 


5387^ 


1838 


2047 


1839 


1529 



The worst year of the series for fever was 1837, "^"^^ '^^^ 
worst month of that year was May, when the fever-deaths were 

^ Cowan, "Vital Statistics of Glasgow," Jottrn. Statist. Soc. III. 

^ Cases at Mile-End Fever Hospital. 

* Including 906 male fever-patients at Albion Street temporary hospital. 



Public health of Glasgow, 1831-39. 



191 



I in 3'22 of the mortality from all causes. That great access of 
fever in Glasgow followed immediately upon the great strike 
of the cotton-spinners, on 8th April, 1837, by which eight 
thousand persons, mostly women, were thrown out of work\ 
The death-rate in Glasgow was in those years as high as anywhere 
in the kingdom, and was higher in the nine years from 1831 
than in the nine years preceding. The population of Glasgow, 
says Cowan, had increased on the industrial side, out of propor- 
tion to its middle and wealthiest class- ; and to that he would 
attribute the higher death-rates in the second period (right-hand 
side), of the following table : 

Glasgow Death-rates. 
1822 — 1830 1831 — 1839 

Death-rate Death-rate 





over all. 


under five 


Year 


One in 


One in 


1822 


44 '4 


lOI 


1823 


36-4 


78 


1824 


37-0 


81 


1825 


36-3 


81 


1826 


40 "6 


105 


1827 


37-0 


84 


1828 


33"o 


79 


1829 


37-9 


100 


1830 


41-5 


97 





Death-rate 


Death-rate 




over all. 


under five. 


Year 


One in 


One in 


183I 


33-8 


79 


1832 


21-67 


63 


1833 


357 


77 


1834 


3^'3 


81 


1835 


32-6 


67 


1836 


28-9 


62 


1837 


24-6 


65 


1838 


37-9 


83 


1839 


36-1 


72 



The high death-rates in some of the years in the second 
column were owing to special causes — Asiatic cholera in 1832, 
smallpox of children in 1835 ^^^ 1836, and to influenza, as well 
as to typhus, in 1831, 1833 ^^^ 1^37- As to the fever which 
prevailed from 1831 to 1836, as it was not relapsing in type, so 
it was not associated with scarcity. 

"The increase of fever in Glasgow," says Cowan, "during the seven 
years prior to 1837, had taken place, not in years of famine or distress, but 
during a period of unexampled prosperity, when every individual able and 
willing to work was secure of steady and remunerating employment. From 
the close of 1836, one of those periodical depressions in trade, arising from 
the state of our monetary system, had visited this city, and deprived a large 
proportion of the population of the means of subsistence^." 

It was then that the cases of typhus trebled in number. 

^ Blackwood's Magazine, March, 1838, p. 289. 

^ In 18 19 the Irish in Glasgow had been estimated at i in 9-67 : in 1831 the Irish 
part of the population had risen to i in ^'6<). Dr Cowan, however, said of them : 
" From ample opportunities of observation, they appear to me to exhibit much less of 
that squalid misery and habitual addiction to the use of ardent spirits than the Scotch 
of the same grade." 

* Robert Cowan, M.D., " Statistics of Fever in Glasgow for 1837." Lancet, 
April 10, 1839. 



192 TypJms mid otJier Contiimed Fevers. 

The epidemic of fever reached its height in Dundee about 
the same time as in Glasgow, and in both towns sooner than 
anywhere else in Scotland or England. One reason of this 
was the labour-troubles culminating in strikes. In the twelve- 
month from 15 June, 1836, to 12 June, 1837, more than three- 
fourths of all the admissions to the Dundee Infirmary on the 
medical side were for fever (700 cases). After the wet autumn 
of 1836 there were a good many cases of dysentery, of which 22 
were treated in the infirmary, with two deaths \ 

At Edinburgh, as at Glasgow, there had been an unusual 
amount of fever in 1831 and 1832, and a steady prevalence of it 
thereafter. The epidemic of 1836-39 was for the most part 
typhus of the winter seasons, declining each spring and dis- 
appearing each summer, except in the summer of 1836, when 
many cases came in June, July and August from airy parts 
of the town^. The climax of the epidemic was in 1838, a year 
later than in Glasgow and Dundee, according to the admissions 
to the fever-wards of the infirmary'^: 

Admissions for Fever, Edinburgh Injiri?iaiy. 



Year 


Cases 


183I 


758 


1832 


1394 


1833 


878 


1834 


690 


1835 


826 



Year 


Cases 


1836 


652 


1837 


1224 


1838 


2244 


1839 


1235 


1840 


782 



At Aberdeen the epidemic appears to have been later even 
than at Edinburgh, if the following admissions to one of the 
two fever-wards (Dr Kilgour's) may be taken as a fair measure 

ofit^: 

Admissions for Fever, Aberdeen. 

Year Cases Deaths 

1838 (March to December) 189 26 

1839 286 29 

1840 534 53 

In all these large towns of Scotland, the fever was purely 
typhus. The various observers all describe the fever as of the 
spotted kind, the proportion of cases with spots varying some- 
what. 

^ James Arrott, M.D., Edin. Med. and Surg. Jourii., Jan. 1839, p. 12 r. 

2 Craigie ibid. April, 1837. 

3 Christison, Monthly fotirii. Med. Sc. X. 1850, p. 262. ^ Kilgour, u. s. 



The Typhus epidemic in Scotland, 1835-39. ^93 

Thus, at Glasgow Infirmary, from 1835 to 1839, there were 4202 cases 
with eruption, 1270 without eruption, and 143 doubtful. And, that the cases 
without eruption were not cases of enteric or typhoid, is probable from the 
record kept of the fatalities in Dr Anderson's fever-wards ^ : 

In 1885 cases with eruption, 275 deaths, or I4"58 per cent. 

„ 324 cases without eruption, 11 deaths, or 3-33 per cent. 

„ 143 cases doubtful, 7 deaths, or 489 per cent. 

At Aberdeen, Kilgour counted 59 cases spotted in a total of 189 in 1838, 
96 in a total of 286 in 1839, and 278 in a total of 534 in 1840, all the cases, 
whether spotted or not, being of the same fever, which he considered 
an exanthematous malady as a whole. Of 169 cases tabulated by Craigie at 
Edinburgh, from 28 June, 1836, to 12 February, 1837, there were 79 with an 
eruption, which was usually the mottled or rubeoloid rash. 

The fatalities were relatively more in Edinburgh than in 
Dundee, comparing two periods which were not the same. Of 
700 cases at Dundee, from June, 1836, to June, 1837, only 50 
died, or i in 14, notwithstanding a good many complications 
from chest complaints and bowel complaints^ At Edinburgh 
during fifteen months of 1838-39, there died 276 in 2037 cases, 
or I in 7'3 ; of those cases, 1075 were in females, with 116 deaths, 
or I in 9, and 962 males, with 160 deaths, or i in 6^ The most 
common age for the fever at Dundee was from twenty to forty 
years (416 out of 700 cases, with 26 deaths, or i in 16), while 
the most fatal age, as usual, was from forty to sixty years, at 
which one person died of three attacked. At Aberdeen, in the 
last year of the epidemic, the years of life from ten to twenty 
had more cases (233 in a total of 657) than any other decade 
of life. The average stay of a patient in the Aberdeen fever- 
wards was i8"67 days. The great preponderance of deaths in 
adolescents or adults was clearly shown in the Glasgow fever- 
statistics, 1835-39. 

Fever-deaths per cent. 
Deaths from Under Over of deaths from 

typhus fever ten years ten years all causes 

4788 . 752 4036 1 1 -57 

The corresponding epidemic of typhus in England had the 
fortune to be recorded in great part under the new system of 
Registration, which came into force on the ist of July, 1837. 
At the beginning of registration of the causes of death, and 
until a good many years after, no distinction was made in the 
published tables between typhus fever and enteric fever. But 
we happen to know that the epidemic of 1837-38 was in London 

^ Cowan, yoiirn. Statist. Soc. ill. 1841. 
^ Arrott, u. s. •'' Craigie, u. s. 

c. II. 13 



194 Typhus and other Contimied Fevers. 

almost wholly typhus, just as it was in the large towns of 
Scotland. Of sixty cases in 1837-38, of which notes were kept 
by West, under Latham at St Bartholomew's Hospital, none 
that died and were examined post-mortem had ulcerations, 
although some had congestion, of Peyer's patches, the cases 
being all reckoned typhus exanthematicus\ Sir Thomas Watson, 
who was then physician to the Middlesex Hospital, says of the 
ulceration of Peyer's patches in continued fever : 

"Since attention has been drawn to the subject, the patches of glands, 
and the whole tract of mucous membrane, from the stomach to the rectum, 
have been diligently explored, and the result seems to be that, at certain 
times and places (in other words, in certain epidemics), the ulceration of the 
inner surface of the intestine is far less common than at others. It was 
comparatively rare in an epidemic of which I witnessed some part in 
Edinburgh [1827-29]. Then I came to London; and for several years I 
never saw a body opened after death by continued fever without finding 
ulcers of the bowels. More recently, however, and especially during the 
present epidemic (1838), I have looked for them carefully, in many cases 
that have proved fatal in the Middlesex Hospital, and have discovered 
neither ulceration nor any other apparent change in the follicles of the 
intestines." And elsewhere he confirms the purely typhus character of the 
epidemic of 1838: "Our wards at the Middlesex are full of it, and scarcely 
a case presents itself without these spots. We speak of it familiarly as the 
spotted fever ; or, from the resemblance which the rash bears to that of 
measles, as the rubeoloid fever^." 

From which it would appear that not even the ordinary 
average number of endemic cases of enteric fever, such as might 
have been expected at a hospital in the west end of London, 
were forthcoming in the epidemic of 1837-38, so purely was the 
type of fever typhus. 

The deaths from this epidemic in London, from the ist of 
July, 1837, to the 31st of December, 1838, were as follows^ : 



1837 




1838 




3rd Quarter 4th Quarter 


ist Quarter 


2nd Quarter^ 3rd Quarter 


4th Quarter 


826 I 107 


1285 


I 176 829 


788 



— a total of 601 1 deaths from fever, nearly all typhus, in eighteen 
months. The worst London parishes were Whitechapel and St 
Pancras, in which latter the fever-hospital was situated. The 
high mortality from fever, which had begun before the ist of 
July, 1837, continued into the year 1839, when the deaths in \ 
London (probably including some enteric) were 18 19. 

^ Edin. Med. and Surg. Jount. July, 1838. 

2 Principles and Praclice of Pliysic, 3rd ed. 1848, II. 742, 732. 

•' First Report of the l\ egi sir ar- General, London, r839. 



The TypJms epidemic in England, 1837-39. 



195 



Over all England and Wales, including London, the last 
six months of 1837 produced 9047 deaths from "typhus," and 
the twelve months of 1838, 18,775 deaths, the winter of 1837-38 
having been the most fatal period. After London, the large 
towns most affected by the epidemic in the latter half of 1837 
were as follows : 





Deaths from 




typhus in 




six months 


Liverpool 


524 


Manchester ) 
and Salford \ 




274 


Birmingham 


75 


Bolton 


IS 


Sunderland 


72 


Leeds 


71 


Sheffield 


68 


Bradford 


65 


Stockport 


63 





Deaths from 




typhus in 




six months 


Dudley 


54 


Abergavenny 


53 


Wolverhainpton 


45 


Newcastle 


44 


Wigan 


43 


Chorley 


41 


Swansea 


36 


Halifax 


IZ 


Macclesfield 


33 


Norwich 


27 



In each of the next two years the number of deaths from 
typhus in the four largest towns was as follows : 





Typhus 


Typhus 




deaths 


deaths 




in 1838 


in 1S39 


Manchester \ 
and Salford ( 


627 


416 


Liverpool 


573 


358 


Leeds 


245 


ISO 


Birmingham 


123 


141 



From nearly all the registration districts of England and 
Wales, deaths from fever were returned in 1837-39, so that the 
contagion must have been very widely spread in town and 
country \ In London the epidemic declined greatly in 1839, 
but in many parts of England the deaths registered as "typhus" 
were hardly less numerous than in 1838, and in some country 
divisions they were more, as if the contagion had taken longer 
to reach the villages^ One village epidemic in North Devon in 
the latter half of the year 1839 had been observed by Dr W. 
Budd, afterwards of Bristol : 

^ The district registrars had hardly organised their work in the first two or three 
years of registration. Some gave much more complete returns than others. Thei'e 
was a reluctance to register births, and the marriages were not all registered. But the 
totals of deaths came out very nearly as the actuaries had expected. 

^ The Third Report of the Registrar-General gives the mortality in all parts of 
England from typhus in 1839 (^-s well as from scarlatina) in an elaborate table of the 
registration districts and sub-districts. 

13—2 



196 Typhus and other Continued Fevers. 

The first case in the village (North Tawton, iioo to 1200 inhabitants) 
was of a young woman in a poor and crowded cottage, who sickened on 
II July, 1839; her mother, brother, and sister sickened in succession, her 
father and a young infant escaping the infection. In another cottage, four 
out of six were ill of fever, in another, three persons had it, and so on, the 
whole number of cases treated by Dr Budd in the village until the beginning 
of November being about eighty. It was carried from North Tawton to 
neighbouring hamlets : thus, a sawyer who lodged next door to the first 
infected cottage sickened of the fever and, on 2 August, returned to his 
home in the hamlet of Morchard. As he lay there, he was visited by a 
friend, who assisted to raise him in bed : "While thus employed, the friend 
was quite overpowered by the smell from the sick man's body," and on the 
tenth day thereafter sickened of fever, which spread to two of his children 
and to a brother who came from a distance to see him. Another sawyer 
who lodged with the former left North Tawton ill a week after him 
(9 August) for his home, also at Morchard, where he died after a period not 
stated ; ten days after his death his two children took the fever, his widow 

escaping it. In a third instance, a widow L left North Tawton on 

21 August to visit her brother, a farmer in the hamlet of Chafifcombe, seven 
miles distant. Two days after her arrival she fell ill of fever and recovered 
slowly. In the same farmhouse the mistress caught it a month or two later 
and died on 4 November ; the farmer himself took to bed with the fever on the 
day his wife died, and came safe through the attack. Three weeks after, an 
apprentice on the farm sickened, then a lad (the fifth in order) in the end of 
December, then the farmer's sister, then another apprentice, then a serving- 
man, then a maidservant, and lastly the daughter of the widow L from 

North Tawton, who had been the first case in the house months before. 
This farmhouse at Chaffcombe sent off two distinct offshoots of contagion. 
The lad, who was fifth in the above series, was sent home ill to his mother's 
cottage, between Bow and North Tawton, in the end of December. His 
mother sickened on 24 January, 1840, and died on 2 February. Next door 
to her lived a married daughter, whose whole household were attacked. 
Another married daughter, who came from a distance to visit the sick, took 
the infection on her return home, and so started a new focus. From the 
same farm at Chaffcombe, the maid, who was ninth in order in the above 
series, was sent home to her father's cottage in the hamlet of Loosebeare, 

four miles away; her father caught the fever from her, and a farmer K , 

who lived across the road, having visited this man several times in his illness, 
took the fever next, other cases following under farmer K's. roof, and there- 
after throughout the whole hamlet of Loosebeare^. 

^ W. Budd, M.D., Lancet, 27 Dec. 1856, and 2 July, 1859. Dr Budd, who had 
been studying in Paris and seeing much typhoid fever, but little or no typhus, in the 
service of Louis at La Pitie hospital, took the whole of these cases for enteric or 
typhoid, and insisted, in his later life, on the ground of his North Tawton experiences 
in 1839, that typhoid fever spread by contagion. He published numerous papers on 
this theme {Lancet, 27 Dec. 1856, another series in the same journal from 2 July to 
Nov. 1859, l^^it. Med. yoiirn. Nov. -Dec. i86r, and, finally, a volume of reprints 
with additions, Typhoid Fever, its Nature, Mode of Sp7-eading and Prevention^ 
London, 1873). But he published no clinical cases nor post-mortem notes, to make 
good his 1839 diagnosis, on which the whole matter turned, contenting himself with 
an assurance that he knew typhoid well from studying it under Louis (who, at that 
time, Ijclieved that the typhus of armies, gaols, &c. and of the British writers, was the 
same as the fever which he, and others after him, named typhoid). He also made the 
following six statements, as if he were making affidavit : (i) that the great majority of 
the cases had early diarrhoea, (2) that three had profuse intestinal haemorrhage, (3) 
that more or less of tympanitis was almost universal in the epidemic, (4) that in nearly 
every case he found the rose-coloiuxd lenticular spots, (5) that one case, which was 
(he only one examined post-mortem, had the characteristic ulceration of the intestine, 



The distress in Ma7ichester, 1839-41. 197 

This was doubtless the way the epidemic spread in all the 
country districts of England, the unwholesome state of labourers' 
cottages, as revealed in the reports of the Poor Law Commission, 
favouring it. In the chapter on the fevers of Ireland we shall 
find that the contagion of typhus and relapsing fever was 
dispersed in the same way, but to a much greater extent, owing 
to the amount of vagrancy. 

In the manufacturing towns of the North of England the 
fever continued at a somewhat steady epidemic level for several 
years. The pathetic scenes of typhus among the poor of 
Manchester in Mrs Gaskell's famous tale of Mary Barton belong 
to the early part of the year 1839; but they might have been 
drawn from almost any months of the two or three years follow- 
ing, according to the passage cited below from the same work\ 

and (6) that one fatal case had the symptoms of perforation of the gut. This summary 
manner, asking in effect to be taken on trust, is not usually accepted from innovators, 
none of the great discoverers having resorted to it. Hitherto, however, no one has 
thought proper to question Budd's diagnosis of the epidemic fever in his North Tawton 
practice, nor even to remark upon his strange error of treating the epidemic of 1838-39 
all over Britain as purely one of typhoid {Lancet, 27 Dec. 1856). But everyone knew 
that typhoid fever did not spread in the way that he described (doubtless correctly for 
the above cases). After the publication of his book in 1873 an attempt was made by an 
influential layman in the Times (9 Nov. 1874) to popularize Budd's fallacies or 
paradoxes on the contagiousness of typhoid. " How," it was asked, after a summary 
of the North Tawton epidemic in 1839, " could a disease whose characters are so 
severely demonstrable, have ever been imagined to be non-contagious? How could 
such a doctrine be followed, as it has been, to the destruction of human life?" 

^ " For three years past trade had been getting worse and worse, and the price of 
provisions higher and higher. This disparity between the amount of the earnings of 
the working classes and the price of their food occasioned, in more cases than could 
well be imagined, disease and death. Whole families went through a gradual 
starvation. They only wanted a Dante to record their sufferings. And yet even his 
words would fall short of the awful truth ; they could only present an outline of the 
tremendous facts of the destitution that surrounded thousands upon thousands in the 
terrible years 1839, ^84°> ^"^i 1841. Even philanthropists who had studied the 
subject were forced to own themselves perplexed in their endeavour to ascertain the 
real causes of the misery; the whole matter was of so complicated a nature that it 
became next to impossible to understand it thoroughly.... The most deplorable and 
enduring evil that arose out of the period of commercial depi-ession to which I refer, 
was this feeling of alienation between the different classes of society. It is so 
impossible to describe, or even faintly to picture, the state of distress which prevailed 
in the town [Manchester] at that time, that I will not attempt it; and yet I think 
again that surely, in a Christian land, it was not known even so feebly as words could 
tell it, or the more happy and fortunate would have thronged with their sympathy and 
their aid. In many instances the sufferers wept first, and then they cursed. Their 
vindictive feelings exhibited themselves in rabid politics. And when I hear, as I have 
heard, of the sufferings and privations of the poor, of provision shops, where ha'porths 
of tea, sugar, butter, and even flour, were sold to accommodate the indigent — of parents 
sitting in their clothes by the fireside during the whole night for seven weeks together, 
in order that their only bed and bedding might be reserved for the use of their large 
; family — of others sleeping upon the cold hearthstone for weeks in succession, without 
[ adequate means of providing themselves with food or fuel — and this in the depth of 
I winter — of others being compelled to fast for days together, uncheered by any hope of 
better fortune, living, moreover, or rather starving, in a crowded garret, or damp 

I 



198 Typhus and other Coitinued Fevers. 

In 1839 the Lancashire deaths from typhus were 1343; in Wales, 

Monmouth and Herefordshire they were 1548. There is, indeed, 

little improvement in the statistical returns as late as 1842. 

The deaths from "typhus" were as follows in all England and 

Wales : 

1838 1839 1840 1841 1842 

'^^i77S 15,666 17,177 14,846 16,201 

The deaths from the epidemic maladies of infants and children during the 
same five years were also very high. 





1838 


1839 


1840 


1841 


1842 


Smallpox 


16,268 


9,131 


10,434 


6,368 


2,715 


Measles 


6,514 


10,937 


9,326 


6,894 


8,742 


Hooping cough 


9,107 


8,165 


6,132 


8,099 


8,091 


Scarlatina 


5,802 


^0,325 


19,816 


14,161 


12,807 


Croup 


4,463 


4,192 


4,336 


4,177 


4,457 


Diarrhoea 


2,482 


2,562 


3,469 


3,240 


5,241 



The epidemic of smallpox corresponded closely to the epidemic of fever, 
the former being fatal chiefly to infants and young children, the latter fatal 
chiefly to adults. Before the smallpox epidemic had subsided scarlet fever 
became unusually mortal, especially in 1840, and kept its higher level 
of deaths for a generation after. The epidemic of fever, although it 
affected the mortality of the young comparatively little, was indirectly a 
reason why many of them died of other diseases ; for the prostration of the 
parents, the impoverishment, and all the other troubles associated with an 
epidemic of typhus, led to inevitable sufferings among the young, which 
weakened their power of resistance. 

The registration returns were not tabulated (except for 
London) from the end of 1842 to the beginning of 1847, but 
there is reason to think that the epidemic fever was not active 
in the interval. It is undoubted that the enormous construction 
of railroads in England during those years gave employment 
and wages to multitudes, and ended the distress the sooner. 
This efifect of railroad-making in England was so obvious that 
Lord George Bentinck desired to relieve the distress in Ireland 
in 1846-47 by the same means. 

Enteric Fever mixed with the prevailing Typhus, 1831-42. 

While there is complete agreement among the hospital 
physicians of the great towns that the fever of 1837-39 was 
maculated typhus, to the total exclusion of cases with ulceration 

cellar, and gradually sinking lander the pressure of want and despair into a premature 
grave; and when tliis has been conlirmed l)y the evidence of Iheir careworn looks, 
their excited feelings, and their desolate homes — can I wonder that many of them, in 
such times of misery and destitution, spoke and acted with ferocious precipitation?" 
Mrs Gaskell, Mary Barton. 



Enteric Fever diudng the TypJms epidemic. 199 

of the bowel, as in the experience of Watson at the Middlesex 
Hospital and of West (under Latham) at St Bartholomew's, 
yet some allowance should be made, in interpreting the figures 
of fever mortality in those years throughout England and Wales, 
for admixture of enteric fever. Budd's statement that the only 
case which was dissected in the epidemic at North Tawton, 
Devonshire, in 1839, had the bowel-lesion of enteric fever, if 
it is to count in the absence of the usual details (place, date, 
objective description), would mean that at least one case there 
was not of the prevailing type of contagious epidemic typhus. 
The coincidence of some such cases is made the more probable 
by the evidence from Anstruther, Fifeshire, reported by John 
Goodsir, afterwards Professor of Anatomy at Edinburgh, who 
was assisting his father in practice there from 1835 to 1839. 
During that period, which was the time of the typhus epidemic 
in the larger towns of Scotland, he attended about one hundred 
cases of fever annually in Anstruther and the neighbourhood ; 
the fever was usually mild, only some sixteen of the cases 
having proved fatal ; of those sixteen he examined ten after 
death, finding " ulceration " of the Beyer's patches in all, and 
perforation of the intestine in four of them. These facts he 
gave orally to Dr John Reid, pathologist to the Edinburgh 
Infirmary, whose experience of the morbid anatomy of fever 
was altogether different. Goodsir, having kept the specimens, 
made them the subject of a paper some years after (1842), in 
which he described very minutely the stages and degrees of 
congestion, ulceration, sloughing and perforation in the lymph- 
follicles of the intestine in fever, placing congestions at one end 
of the scale and sloughing at the other, as the French patho- 
logists then did\ Reid examined, at the Edinburgh Infirmary 
from October, 1838, to June, 1839, forty-one bodies dead of 
fever, to see whether the intestinal lesion, which Goodsir had 
told him of, occurred in them. The distinctness of the Beyer's 
patches varied a good deal (differences which are known to be 
in part congenital and in part to depend on age), and in only 
two instances were they elevated and seemingly " ulcerated." 

^ John Goodsir, "On a Diseased Condition of the Intestinal Glands," Lond. and 
Edin. Monthly Jown. of Med. Science, April, 1842. He does not enter on the 
question " as to whether the subject of the present paper constitutes a distinct species 
of disease, or be merely a form of the ordinary continued fever"; but he appears to 
recognize that a certain district may have a form of fever special to it, as Reid had 
probably told him. 



200 Typhus and other Continued Fevers. 

One of these was the case of an Irishman, fronri Sligo, aged 25, who had 
been so constipated that he was purged with colocynth, etc. : "at the lower 
part of the ileum, the elliptical patches were irregular on the surface, and 
presented several superficial and ill-defined depressions (ulcerations)." The 
other was the case of a girl, aged 15, who had not suffered from diarrhoea, 
but ha,d the intestinal patches elevated and superficially "ulcerated^." 
Neither of these cases would probably be reckoned typhoid or enteric fever 
at the present time on the anatomical evidence only. The early French 
observers, Chomel, Louis, Andral and others, included in a scale all the 
appearances of the Peyer's patches in fever that they thought morbid, from 
mere prominence of the lymphatic tissue and distinctness of the follicular 
pits, up to extensive sloughing and ulceration of the same, as if they were all 
the signs of one and the same fever in its various stages of development. 
But simple prominence or congestion of Peyer's patches may occur in typhus 
fever, or in relapsing fever; nor would a slight erosion, or "superficial 
ulceration" raise in all cases a suspicion of enteric fever. 

The observations of Home, Reid's predecessor as pathologist 
to the Edinburgh Infirmary, from 1833 to 1837, were however 
conclusive that true enteric fever had occurred now and again 
during the steady prevalence of typhus fever from year to year. 
In that space he made loi post-mortem examinations in fever- 
cases; in 29 the Peyer's patches were distinct, in 7 of those 29 
there was " a greater or less degree of ulceration," and in 2 of 
those 7 there was perforation ^ Murchison examined the 
post-mortem register of the Edinburgh Infirmary for the 
years 1833 to 1838, and found only fifteen cases of fever 
with ulceration of the bowel. But in the eight months from 
I November, 1846, to June, 1847, there were nineteen dissections 
with the characteristic lesion of typhoid, the season having been 
remarkable everywhere for that disease. 

In the following series of years the fatal cases of fever in 
the Edinburgh Infirmary with ulceration were few^ : 

Year Enteric deaths 

1858 I 

1859 2 
i860 I 

1861 6 

It was thought remarkable that the form of continued fever 
which was most usually found in the great continental cities, 
in Paris, Berlin, Prague and Vienna, namely that with ulceration 
of the lymph-follicles of the intestine, should be but occasionally 
mixed with the old typhus in England, Ireland and Scotland 

^ John Reid, M.l)., "Analysis and Details of Forty-seven Inspections after Death," 
Edin. Med. and Stirg. your 11., Oct. 1839, ?• 456- 
" Reid, u. s., from Home's records. 
^ Murchison, Conliimed P'a<crs, iw\ ed. 1873, p. 444. 



Year 


Enteric deaths 


1854 
185s 
1856 
1857 


5 

2 

I 

8 



Relative frequency of Typhoid in Britain. 201 

in the very same years. But there was nothing to discredit the 
British observations, anatomical and cHnical ; and in 1836 
Dr Lombard, of Geneva, having visited various cities in 
England, Scotland and Ireland bore witness to the matter of 
fact, strange as it was to him. Writing to Graves, of Dublin, 
on 16 June, 1836, he said: "Before I leave Ireland, allow me 
to express to you my great astonishment at what I have seen 
in this country respecting your continued fever ; " and in a 
second letter, of 18 July, after his return to Geneva, he added, 
that in Liverpool, ulceration of the ileum in continued fever 
was "occasional," that in Manchester he had been told it 
occurred " by no means always," that in Birmingham the cases 
of fever were not many, but " always " with intestinal ulceration, 
and that in London "not a fourth part" of the cases of fever 
had the latter condition, and these mostly in autumn \ This 
was before the great epidemic of typhus had begun in the 
English towns. To the same non-epidemic period (1834) 
belongs the statement of Carrick, for Bristol, that fever was 
often observed to be infrequent or altogether absent in the most 
crowded and dirty parts of the city at times when there were 
a good many cases " in institutions and dwellings where 
cleanliness and free air are most carefully attended to," and that 
ulceration of the bowel was the most common post-mortem 
appearance^ 

The comparative rarity of enteric fever in the chief towns 
of Scotland and Ireland continued for a good many years longer, 
indeed until after the differences between typhus and typhoid 
were perceived and admitted by all. Even at the London Fever 
Hospital, during twenty-four years (1848-71) after Sir William 
Jenner's diagnostic points were strictly looked to in its wards, 
much the greater part of the admissions were of typhus ; in 
only two periods, 1850-55 and 1858-61, during both of which 
there was comparatively little fever of any kind in London, did 
the admissions for enteric fever slightly exceed those for 
typhus ; on an annual average of the twenty-four years ending 
1 87 1, the cases of the former were only about a fifth part of the 

^ Lombard, in Dublin yournal of Med. Sc. x. {1836), p. 17. He bore witness, 
also, to the rarity of the bowel-lesion in the Glasgow fevers. This was confirmed by 
Dr Perry, of that city, Ibid. x. 381. See also Julius Staberoh, M.D., " Researches on 
the Occurrence of Typhus in the Manufacturing Cities of Great Britain," Ibid. Xiii. 
426. 

^ Trans. Prov. Med. Assoc, il. (1834), p. 176. 



202 TypJms and other Contiimed Fevers. 

whole. The cases of enteric fever increased decidedly after 
1865. Murchison thought that the increase might be accounted 
for in part by the enlargement of the Fever Hospital, and by 
the unusually high temperature of certain years, the summers and 
autumns of 1865, 1866, 1868 and 1870 having been remarkable 
for their great heat and prolonged drought ; but, he adds, 
" it is not a little remarkable that this increased prevalence of 
enteric fever in the metropolis has been contemporaneous with 
the completion of the main drainage schemed" 

Still more recently, the relative proportions of typhus and 
enteric fever have been reversed, so that there have been years 
with little or no typhus but with a good deal of enteric fever. 
There are some persons, unacquainted with the history, who 
cannot imagine that it was ever otherwise than now, who think 
of the former times of medicine, not as differing in social, 
economic, and various other respects from their own, but only 
as being less clever at diagnosis. There are others who realize 
clearly enough the historical matter of fact, but find it necessary 
to explain the almost contemporaneous decline of typhus and 
rise of typhoid by some hypothesis of the latter being " evolved " 
out of the former. This evolutional doctrine makes the 
mistake of ascribing to the species of disease the same 
comparative fixity of characters that belongs to the species of 
animals and plants. Beside the latter, the species of disease 
are the creatures of a day. In the nosological field, the origin 
of species is not analogous to the evolution of a new species 
of animal or plant out of an old, as in the hypothesis of Darwin, 
for the reason that every species of disease is evolved directly 
and, as it were, p7'o re nata, out of a few simple conditions of 
human life, variously mixed but always there to give occasion 
to one infective malady or another, which may have a shorter 
existence, like sweating sickness, or a longer, like plague. 
Edinburgh experiences offer a ready criticism of the evolutional 
doctrine. Typhus declined, and typhoid rose ; but it was in the 
old tenement houses of the Canongate, Cowgate, Grassmarket, 
and High Street that typhus declined, and it was mostly in the 
new streets across the valley, or in the New Town of Edinburgh, 
that enteric fever arose, having sometimes no miOre mysterious 
an origin than the results of defective or cheap plumber-work, 

' Conlinued Feziers, 2ncl cd. 1873, p. 443. 



Return of Relapsing Fever in 1842. 203 

for example, the leakage of a soil-pipe fermenting-, a foot deep, 
beneath the basement floor. But it was not until a good many 
years after that these new experiences became common ; and 
meanwhile Edinburgh and other towns in Scotland saw much 
of typhus and relapsing fever. 

Relapsing Fever in Scotland, 1842-44. 

The epidemic of 1836-39 had been typhus of a specially 
maculated kind. The period or " constitution " of synocha, 
rising twice to epidemics of relapsing fever, had lasted from 
near the beginning of the century until 1828 or 1829. Then 
came the new constitution of low, depressed, spotted fever, 
which would not stand blood-letting. But in 1842-44 relapsing 
fever reappeared in Scotland. This reappearance was a blow 
to two doctrines of the time — first that Ireland Was the original 
breeding-place of all such fevers, and secondly, that a return 
of the "constitution" of relapsing fever would warrant a return 
to the practice of blood-letting, which had fallen into disuse 
during the epidemic of typhus. The epidemic of 1842-44 
was at first purely a Scots affair, with some extension to 
England, but none to Ireland. As to blood-letting, once it 
had been given over in fevers it was not readily taken up again, 
notwithstanding the theory that relapsing fever belonged to those 
sthenic or inflammatory types of sickness in which the lancet 
was still thought admissible. Moreover, Christison, who re- 
membered the relapsing synocha of 1817-19 and of 1827-28, 
said of the third epidemic : " The synocha of 1 843-44, though 
so prevalent, by no means presented the same strong phlogistic 
or sthenic character as in the earlier epidemics of 1817-20 and 
1826-29. The pulse was neither so frequent nor so strong ; the 
heat was not so pungent ; the glow of the integuments was less 
lively and less general." 

I take conveniently from Murchison the following succinct 
account of the Scots relapsing fever of 1842-44^ : 

" The next epidemic of fever in 1843 differed from those that preceded it, 
inasmuch as it did not originate in or imphcate Ireland, but was mainly- 
confined to Scotland. There was no increase of fever in the Irish hospitals 

1 Christison, " On the Changes which have taken place in the Constitution of 
Fevers and Inflammations in Edinburgh during the last forty years." Paper read at 
Med. Chir. Soc. Edin. 4 March, 1857. Edin. Med. Jonrn. Jan. 1858, p. 577. 

^ CoHtimied Fevers, under the head of " Typhus," p. 47. 



204 TypJiiis and other Continued Fevers. 

during this year, whereas the number of admissions into the Glasgow 
Infirmary rose from 1,194 to 3,467; in the Edinburgh Infirmary from 842 to 
2,080; and in the Aberdeen Infirmary from 282 to 1,280. These numbers, 
too, are far from representing the true extent of the epidemic, for thousands 
of sick were sent from the hospital doors. The fever was almost exclusively 
relapsing fever ; typhus was comparatively rare. The first cases were 
observed on the east coast of Fife, in 1 841-2 (by H. Goodsir), and not 
in the crowded localities of large towns. In Dundee, where the proportion 
of typhus cases was comparatively great, the fever appeared early in the 
summer of 1842, and raged to a considerable extent during the whole of the 
autumn, before it showed itself elsewhere. In Glasgow the first cases 
occurred in September, 1842; but the fever was not generally prevalent 
until December, from which month the cases rapidly increased until 
October, 1843, when the epidemic began to decline. The number of cases 
in Glasgow was estima,ted at 33,000, or i\\ per cent, of the entire population. 
In Edinburgh relapsing fever was first observed in February, 1843. It 
rapidly spread until October, after which it gradually abated, until, by the 
following April, it had well nigh disappeared. In the month of October, 

1843, the number of fever cases admitted into the Edinburgh Infirmary 
amounted to 638, and during several months, from thirty to fifty cases were 
daily refused admission. The total number of cases in Edinburgh was 
calculated by Alison at 9,000. In Aberdeen the epidemic commenced about 
the same time, and followed the same course as in Edinburgh. At Leith, 
curiously enough, it did not appear until September, 1843 ; it then spread 
rapidly for two months, after which it declined, and by the end of February, 

1844, it had almost ceased ; but during this brief period it attacked 1,800 
persons, or one in every fourteen of the population. The disease was 
general over Scotland, and was not restricted to the large towns ; it prevailed 
in Greenock, Paisley, Musselburgh, Tranent, Penicuick, Haddington, Dunbar, 
the Isle of Skye, etc. Although the epidemic was mostly confined to 
Scotland, the same fever was observed in some of the large towns of 
England. The number of admissions into the London Fever Hospital rose 
from 252 in the preceding year to i;385 in 1843: and the annual report for 
1843 makes it evident that a large proportion of these cases were relapsing 
fever. The rate of mortality of the epidemic was small, not exceeding from 
two-and-a-half to four per cent. Although this was the same fever as 
prevailed in 18 17-19, even local bleeding was rarely resorted to, and many 
of the cases were thought to demand stimulants. All accounts agree in 
stating that the epidemic supervened upon a period of great distress among 
the Scottish poor, and that it was restricted throughout to the poorest and 
most wretched of the population." 

This epidemic, which was the subject of an altogether 
unusual amount of writing in Edinburgh', partly on the sup- 
position that relapsing fever was a " new disease," proved once 
for all that one had not to go to Ireland for the engendering or 
making of a famine-fever. The demonstration came just in 
time ; for the epidemic was hardly over in Scotland, when the 
series of great potato-famines in Ireland began in 1845, soon to 
be followed by the disastrous epidemics of dysentery, relapsing 

1 See especially John Rose Covmack, M.D., Natural History, Pathology and 
Treat iiicnt of the Epidemic Fever at present prevailing in Edinburgh and other towtts. 
Loud. 1.S43 ; and the papers by Wardell, Lond. Med. Gaz. N. s. 11 — v. 



The Typhus epidemic of 1847-48. 205 

fever and typhus from 1846 to 1848. Indeed, so near was the 
Scots epidemic to the Irish, that in the North of Ireland the 
first of the relapsing fever, in 1846, was called "the Scotch 
Fever," on the supposition that it had reached them from its 
recent focus in the West of Scotland \ The Irish and original 
part of the great epidemic of 1846-48 has been fully described 
in another chapter ; much of the mortality was due to dysentery, 
and the most prevalent fever was relapsing fever, with a very 
low rate of fatality among the poorer classes. But in Ireland 
itself there was also much typhus, very mortal to the richer 
classes who came in contact with the starving multitudes. 



The "Irish Fever" of 1847 in England and Scotland. 

The contagion that reached England and Scotland from the 
scene of famine in Ireland was more apt to produce typhus than 
relapsing fever. That the Irish contagion was the principal 
source of the great epidemics in England and Scotland in 
1847-48, seems to be proved by every fact in their progress, 
direction and other circumstances. But it is not so clear that 
England and Scotland would not have had an unusual amount 
of typhus in the same years even if the Irish had been kept out 
by an ideally strict quarantine. What touched Ireland most, 
touched Scotland and England in a measure. The seasons 
were bad in all parts of the kingdom ; many were out of work 
in the manufacturing towns ; but as soon as the price of pro- 
visions fell in 1848, the epidemic in England came to a sudden 
end. 

The epidemic of fever in England in 1847 was almost 
wholly typhus ; in Scotland, it was to some extent relapsing 
fever, but there also it was mainly typhus. It was more severe, 
while it lasted, than the epidemic of 1837 and following years; 
but it was of shorter duration, ceasing almost abruptly in 1848. 
The rise of the epidemic of 1847 in London is shown by the 
following quarterly returns of the deaths from fever : 

ist Quarter 2nd Quarter 3rd Quarter 4th Quarter 
442 568 895 1279 

In the last quarter of 1846, the deaths from fever in London 

1 Dr Betty, of Lowtherstown, Fermanagh, Dull. Quart. Jotirn. Med. Sc.vw. 11$. 



2o6 Typhus and other Contimied Fevers. 

had been 619. In all England, the last quarter of 1846 was also 
most unhealthy, its deaths from all causes being 53,055 (only 
43,850 in the first quarter of the year). The summer of 1846 had 
been remarkable for heat and drought, and the end of the year 
was, according to precedent, an unwholesome time. It was just 
the season for enteric fever, as in the still more memorable 
circumstances of 1826. There is evidence from various parts 
of England and Scotland that much of the fever of the end of 

1846 was enteric; and it was doubtless the unusual prevalence 
of that disease, and of other maladies that are favoured, like it, 
by extreme fluctuations of the ground-water, that explains the 
very high mortality of the last quarter of 1846^ But it is 
equally certain that it was typhus which raised the fever deaths 
in London in the last quarter of 1847 to 1,279, ^•'^d the deaths 
from all causes in all England to the enormous total of 57,925. 
In the whole of the year 1847, typhus alone claimed 30,320 
deaths in England and Wales, the total in 1848 falling to 21,406. 
Lancashire and Cheshire had the largest share of this epidemic, 
and Liverpool the largest share in Lancashire. In that Regis- 
tration Division (the North-western) the deaths from typhus in 

1847 were 9,076, and in 1848 they were 3,380. Next in order 
(excluding London and suburbs) came the West Midland Divi- 
sion, and next to that Yorkshire. At Liverpool, and in other 
places of the north-west of England, the fever was very clearly 
connected with the enormous Irish immigration, and was in 
great part among the Irish. There were floating lazarettos on 
the Mersey, filled with fever and dysentery, workhouses over- 
flowing, and sheds hastily built to hold each 300 patients. The 
following returns from the several sub-divisions of Liverpool 
for the months of July, August and September, 1847, show the 
proportions of dysentery and fever, as well as the mortality from 

^ Murchison says that the enteric fever of the end of 1846 was prevalent at many 
places in England where the epidemic of typhus never made its appearance, and that 
in Edinburgh (according to an unpublished essay by Waters) most of the enteric cases 
not only occurred prior to the outbreak of the epidemic of Irish fever, but came from 
localities in the neighbouring country and from the best houses of the New Town — 
not from the crowded courts of the Old Town, to which the later epidemic of typhus 
and relaj^sing fever was restricted. Murchison, u. s. p. 49. The following papers 
relate to the autumnal typhoid of 1846 in England : Sibson, " Fever at Nottingham 
and neighbourhood in Summer and Autumn of 1846," Med. Gaz. xxxix. ; Taylor, 
"Fever at Old and New Lenton in 1846," Med. Times, xv. 159 and Med. Gaz, 
XXXVIII. 127; Turner, "Fever at Minchinhampton in Autumn ]846," ATcd. Gaz. 
XLii. 157; Brenchley, " Fever in Berkshire in 1846," Tl/cv/. Gaz. xxxviii. 1082; Bree, 
"Epidemic Fever at Great Finborough in Autumn of 1846," Prov. Med. and Surg, 
ymirn. 1847, p. 676. 



TypJms in the North of England, 1847-48. 207 

diarrhoea, which last was, mostly an affair of the infants and 
young children^ : 

Liverpool deaths, Jiily — Sept. 1847. 

Fever Dysentery Diarrhoea 

St Martin's 291 82 174 

Dale Street 250 20 11 1 

St Thomas (301 deaths on the floating lazarettos) 

Mount Pleasant 324 18 73 

Islington 105 37 78 

Great Howard Street (the fever extending to the upper classes) 

In his report for the quarter before (April, May and June, 
1847) the registrar of the Great Howard Street sub-district says: 
" Eight Roman Catholic priests, and one clergyman of the 
Church of England, have fallen victims to their indefatigable 
attentions to the poor of their church I" 

In Manchester there were causes of fever independently of 
the Irish contagion. The registrar of the Deangate sub-district 
writes in the third quarter of 1847 : "In the calamitous season 
just pa!Ssed, manufactures have been almost at a stand-still ; 
food has been unattainable by the poor, for employment they 
had none ; Famine made her dwelling in their homes &c." The 
hardships of the children caused an immense mortality from 
summer diarrhoea. The same registrar gives an account of the 
epidemic fever in his report for the second quarter of 1847, from 
which it appears that, although nearly all the hospital cases were 
distinctly maculated, and the fever was undoubtedly typhus in 
all other respects and in its conditions, yet tympanitis, with 
abdominal tenderness and diarrhoea, were specially noted^ 

Besides Liverpool and Manchester, many other towns in 
Lancashire had the "Irish fever" in them; also Birmingham, 
Dudley, Wolverhampton, Shrewsbury, Leeds, Hull, York and 
Sunderland. Except in London, the fever mortality was not 
unusual in the southern half of England*. 

^ In the Report of t tie Registrar- General for ttie year 1847. 
: ^ This was the occasion which furnished Father Newman with a famous argument 
for the bona fides of his co-religionists: " The Irish fever cut off between Liverpool and 
Leeds thirty priests and more, young men in the flower oiF their days, old men who 
seemed entitled to some quiet time after their long toil. There was a bishop cut off 
in the North ; but what had a man of his ecclesiastical rank to do with the drudgery 
and danger of sick calls, except that Christian faith and charity constrained him?" 
John Henry Newman, D.D., History of My Religious Opinions, London, 1865, p. 272. 

* Leigh, in Report Reg.- Gen. for 1847, X. p. xx. 

^ H. M. Hughes, "On the Continued Fever at present existing in the southern 
districts of the metropolis," Lond. Med. Gaz. Nov. 1847; Laycock, "Unusual 



2o8 Typhus and otJier Contimied Fevers. 

In Scotland the epidemic was a mixture of relapsing fever 
and typhus. The following were the proportions of each ad- 
mitted to the Glasgow Royal Infirmary : 



Year 


Relapsing Fever 


Typhus 


1846 


m 


500 


1847 


2,333 


2,399 


1848 
1849 


513 

168 


980 
342 



In the Barony Fever Hospital, Glasgow, open from 5 August 
1847 to July 1848, the relapsing cases were double the typhus 
cases at the opening of the hospital, at the end of 1847 they 
were nearly equal, and from February 1848 the typhus cases 
were double the relapsing. In Edinburgh, where the epidemic 
was less severe, the same relations were observed — relapsing 
fever most at the beginning, typhus fever (much more fatal) 
most at the end^ Some relapsing fever occurred also in 
London, among destitute Irish, which was often attended by 
a miliary eruption (Ormerod). 



Subsequent Epidemics of Typhus and Relapsing 
Fevers. 

By midsummer, 1848, there was a most marked improvement 
in the public health, corresponding with the great fall in the 
prices of food, under the influence of free trade, and with a 
good harvest and the commencement of an era of steady em- 
ployment for workers. The improvement is strikingly shown 
in the following comparison of the deaths from all causes in 



prevalence of Fever at York," Lond. Med. Gaz. Nov. 1847; Bottomley, "Notes on 
the Famine Fever at Croydon in 1847," Prov. Med. and Surg, yourn. 1847; 
Ormerod, Clinical Observations on Cotttinued Fever at Bartholoineiu's Hospital, Lond. 
1848 ; Art. in Brit, and For. Med. Chir. Rev. 1848, i. 285 ; Duncan, Joiirti. Pub. 
Health, I. 200 (Liverpool); Paxton, P7-oz). Med. Jonrn. 1847, pp. 533, 596 (Rugby). 
' The following papers relate to the epidemic in Scotland in 1847 : Orr, " His- 
torical and Statistical Sketch of the progress of Epidemic Fever in Glasgow during 
1847," Edin. Med. atid Siirg. jfonrtt. LXix. ; Stark, "On the Mortality of Edinburgh 
and Leith for 1847," ^l^'d. and LXXi. ; R. Paterson, "Account of the Epidemic Fever 
of 1847-8" in Edinburgh, Ibid. Lxx.; W. Robertson, "Notes on the Epidemic Fever 
of 1847-8," Moftt/i. Jonrn. of Med. Sr. IX. 368 ; J. C. Steele, " View of the Sickness 
and Mortality in the Glasgow Royal Infirmary during 1847," Fdin. Med. and Surg, 
yojcrn. LXX.; J. C. Steele, "Statistics of the (Glasgow Infirmary for 1848," Ibid. 
Lxxii. 241 ; J. Paterson, "Statistics of the Barony Parish Fever Hospital of Glasgow 
in 1847-8," Ibid. i.xx. 357. 



The TypJms of the ^^Cotton-famine'' 1862-65. 209 

Lancashire and Cheshire in the third quarter of each of the years 
1846, 1847 and 1848 : 

1846 1847 1848 

Deaths in the 3rd Quarter 15,221 17,080 11,720 

Since the epidemic of 1847, which was not unfairly called 
" the Irish fever," there has been no such extensive and fatal 
outbreak of typhus or relapsing fever in England, Scotland or 
Ireland. The fever deaths rose somewhat in Ireland and in 
Glasgow in 1851-53, the type of disease being relapsing and 
typhus. In London there was a considerable increase of typhus 
in 1856, at the end of the Crimean War. From 1861 to 1867 
there was a considerable epidemic of the same fever in England 
and Scotland (not much of it in Ireland until 1864), the chief 
centres in England having been the Lancashire towns, Preston, 
Manchester, Accrington, Chorley, Salford and Blackburn, and 
the occasion of it the " cotton famine " of the American Civil 
War\ Greenock was the chief seat of typhus in 1863-64 in 
Scotland ; indeed, in the whole kingdom, its death-rate from that 
cause was approached by that of Liverpool only. Fevers had 
been very mortal there in the epidemic of 1847 (it is said 353 
deaths); in the next fever-period they rose as follows^ 

i860 1861 1862 1863 1864 

19 57 63 98 274 

This epidemic was more easily dealt with than those of the 
same kind before it. Very large sums were subscribed by the 
wealthy, of which, indeed, a considerable balance remained 
undistributed. Rawlinson, as engineer, and Villiers, as Minister, 
devised extensive relief works, in the form of main drainage for 
the distressed Lancashire towns, the whole cost being defrayed 
eventually by the municipalities themselves. The following 
table, from Murchison, shows the admissions for typhus to 
the fever hospitals of various towns, subsequently to the great 
epidemic of 1847-48. The first rise in London was in 1856; 
the next rise, which was somewhat prolonged, coincided with 
the epidemic in Lancashire. 

^ Buchanan, i?^/^r^i^^(/. Officer- Privy Cotmciljor 1864, and Trans. Epid. Soc. 1865, 
II. 17; HamiUon, Lancet, li. 1867, p. 608 (Liverpool); Martyn, Brit. Med. Joiirn. 
July, 1863 ; Davies, Med. Times and Gaz. 11. 1867, p. 427 (Bristol) ; Thompson, 
St George's Hosp. Reports, i. (1866), p. 47 (London) ; Allbutt, ibid. p. 61 (Leeds). 

2 Buchanan, Report Med. Off. Privy Cotmcilfor 1865, p. 210. 

c. II, r4 



210 Typhus and other Continued Fevers. 



Hospital Cases of Typhus, 1849 — 71. 

London Edin. Glasgow Glasgow Dundee Aberdeen Cork 

Fever Royal Royal Fever Royal Royal Fever 



Year 


Hosp. 


Infirm. 


Infirm. 


Hosp. 


Infirm. 


Infirm. 


Hosp 


1849 


155 


— 


342 


— 


— 


— 


— 


1850 


130 


— 


382 


— 


— 


— 


— 


1851 


68 


— 


919 


— 


— 


— 


— 


1852 


204 


— 


1293 


— 


— 


— 


— 


1853 


408 


— 


1551 


— 


— 


— 


— 


1854 


?>yi 


— 


760 


— 


— 


— 


— 


185s 


342 


— 


385 


— 


— 


— 


— 


1856 


1062 


— 


385 


— 


— 


— 


— 


1857 


274 


— 


314 


— 


— 


— 


— 


1858 


IS 


— 


175 


— 


17 


— 


— 


1859 


48 


— 


175 


— 


128 


— 


— 


i860 


25 


— 


229 


- — 


67 


— 


— 


1861 


86 


— 


509 


— 


129 


— 


116 


1862 


1827 


14 


780 


— 


54 


— 


272 


1863 


1309 


74 


1286 


— 


236 


379 (4 mos.) 


692 


1864 


2493 


212 


2150 


— 


264 


811 


I02I 


1865 


1950 


447 


2334 


II54 


891 


422 


791 


1866 


1760 


847 


1055 


384 


706 


167 


247 


1867 


1396 


303 


761 


795 


22 ? 


68 


124 


1868 


1964 


280 


620 


1023 


502 


78 


245 


1869 


1259 


259 


1430 


2023 


402 


170 


136 


1870 


631 


287 


947 


702 


232 


61 


165 


187I 


411 


lOI 


418 


511 


257 


3 


397 



During the unusual prevalence of fever in Scotland, 1863-65, 
it was made clear by the diagnosis in hospitals, that the excess 
was caused by typhus, and not by enteric. 

Of 440 cases of fever treated in the Royal Infirmary of Edinburgh, in 
1864, 212 were cases of pure typhus, 140 were enteric fevers, while 88 were 
simple continued fever and febricula. In the Royal Infirmary of Glasgow in 
1864, of 2,190 cases of fever, 2,150 were reported to be cases of typhus fever, 
while only 40 were cases of enteric fever. In the Aberdeen Royal Infirmary 
not a case of enteric fever was observed : of 396 cases in the year 1863, 387 
were pure typhus, and 9 febricula; and in 1864, of 926 cases, 897 were pure 
typhus and 29 febricula. In the Royal Infirmary of Dundee, of 355 cases of 
fever treated in 1864, 318 were typhus, 16 enteric fever, and 21 febricula. 
It was only at Perth, and there not exclusively in hospital practice, that an 
excess of typhoid fever was observed ; from ist August, 1863, to 30th April, 1864 
(months which included the special typhoid season), there were loi cases of 
gastro-enteric or typhoid fever, 46 cases of typhus, 19 of relapsing" fever, and 
59 of simple continued fever 1. 

The last considerable prevalence of contagious fever in 
England and Scotland was in 1869 and 1870. It was relapsing 
fever, mixed with some typhus, and it was restricted almost to 

' James Stark, M.D., "Remarks on the Epidemic Fever of Scotland during 
1863-64-65 " etc., Traits. Epideni. Soc. N. S. Ii. 312. See also Russell, Glasg. Med. 
Jonrn, July, 1864, and R. Beveridge (for Aberdeen), Lancet, i. 1868, p. 630. 



Co7itimied Fevers since 1869. 211 

a few large towns, including London, Liverpool, Manchester, 
Leeds, Bradford, Glasgow, and Edinburgh \ It was first seen 
in London in 1868 among Polish Jews. It was heard of as late 
as 1872 at Newcastle. It was observed during this epidemic in 
Liverpool, Bradford and Edinburgh that the subjects of the 
relapsing fever were not suffering from want^ The same obser- 
vation has been made in some foreign countries. Still, on the 
great scale and in a broad view, relapsing fever has been typJuis 
famelicus or famine-fever, occurring in association with other 
maladies due to want, and especially in the circumstances which 
have been discussed fully in the chapter on fevers in Ireland. 



Relative prevalence of Typhus and Enteric Fevers 
since 1869. 

It was not until the year 1869, or about the time when 
typhus fever ceased to be epidemic or common, that the deaths 
from typhus fever, simple continued fever and enteric fever 
began to be tabulated separately in the Registrar-General's 
reports. The following tables show for England and Wales and 
for London a steady decline of the deaths from typhus and 
simple continued fever since the end of the epidemic period 
1869-71, which was the last epidemic of typhus and relapsing 
fever in this country hitherto. The deaths from enteric fever, it 
will be seen, remained somewhat steady (in a growing popula- 
tion) for about ten years after the separation, and then began to 
decline. 

^ Weber, Lancet, l. 1869, pp. 221, 255; Murchison, ibid. il. 1869, pp. 503, 647 ; 
Gee (Liverpool), j5rzy. Aff^/. Jottrn. 11. 1870, p. 246; Robinson (Leeds), Lancet, i. 
1 87 1, p. 644; Muirhead (Edinburgh), ^a'/w. Med.Journ. July, 1870, p. i ; Rabagliati 
(Bradford), ibid. Dec. 1873; Tennant (Glasgow), Glasgozv Med. Jotirti. May, 1871, 
p. 354; Armstrong (Newcastle), Lancet, i. J.873, p. 48. 

^ Muirhead (1. c.) says : " In no single instance which came under my observation 
could starvation be said to be the immediate cause of the disease. Not one of those 
individuals could be said to be emaciated.... On strict and repeated inquiry, not one of 
them would confess to having been in destitute circumstances." During the winter 
of 1870-71 I attended from the Edinburgh New Dispensary several relapsing-fever 
patients at their homes, and can clearly remember having been surprised at the 
condition of decency and comfort in which I found them. The appearance of comfort 
was certainly due in part to the district visitors, who were numerous and active during 
the epidemic. 



14- 



212 Typlms and other Contimted Fevers. 

Continued-fever Deaths in England and Wales, 1869-91. 







Simple or 




Year 


Typhus 


Ill-defined 


Enteric 


1869 


4281 


5310 


8659 


1870 


3297 


5254 


8731 


187I , 


2754 


4248 


8461 


1872 


1864 


3352 


8741 


1873 


1638 


3081 


8793 


1874 


1762 


3089 


8861 


1875 


1499 


2599 


8913 


1876 


I 192 


1974 


7550 


1877 


I 104 


1923 


6879 


1878 


906 


1776 


7652 


1879 


533 


1472 


5860 


1880 


530 


1490 


6710 


1881 


552 


1159 


5529 


1882 


940 


1016 


6036 


1883 


877 


963 


6068 


1884 


328 


768 


6380 


1885 


318 


662 


4765 


1886 


245 


505 


5061 


1887 


211 


502 


5165 


1888 


168 


436 


4848 


1889 


140 


413 


4971 


1890 


160 


361 


6146 


1 891 


148 


325 


5075 



Continued-fever Deaths in London, 1869-91. 







Simple or 




Year 


Typhus 


Ill-defined 


Enteric 


1869 


716 


615 


1069 


1870 


472 


570 


976 


1871 


384 


436 


871 


1872 


174 


322 


867 


1873 


277 


3^5 


968 


1874 


312 


337 


879 


1875 


128 


272 


817 


1876 


159 


202 


769 


1877 


157 


194 


901 


1878 


151 


197 


1033 


1879 


71 


160 


849 


1880 


74 


134 


702 


1881 


92 


134 


971 


1882 


53 


95 


975 


1883 


55 


102 


963 


1884 


32 


75 


925 


1885 


28 


78 


597 


1886 


13 


73 


618 


1887 


19 


44 


612 


1888 


9 


35 


694 


1889 


16 


42 


538 


1890 


10 


35 


604 


1 89 1 


II 


44 


557 



Typhus and Typhoid at the London Fever Hospital. 213 

Such being the proportions of typhus and enteric fever since 
1869, when the separation was made, it remains to ask what 
share each of them may have had in the total of " typhus," or of 
continued fever generally, in the years before the two forms were 
distinguished in the annual registration reports. Of course, they 
were distinguished by many of the profession long before that ; 
so that there are means of forming a judgment. At the London 
Fever Hospital, enteric fever and typhus were distinguished after 
1849. If the admissions of each kind of fever to that hospital 
be assumed to have been proportionate to the prevalence of each 
in London from year to year, we should get in the following 
table a means of estimating which of the two forms of continued 
fever furnished most of the deaths in all London, as given in the 
first column : 

Admissions to London 
Deaths in Fever Hospital 

London from 
Year both fevers Typhus Typhoid 

1838 4078 — — 

1839 1819 — — 

1840 1262 — — 

1841 II5I — — 

1842 1 184 — 

1843 2094 -r- — 

1844 I72I 

1845 1324 — — 

1846 1838 — — 

1847 3297 — — 

1848 3685 — — 

1849 2564 

1850 2032 

1851 2374 

1852 2183 

1853 2617 

1854 2816 

1855 2410 

1856 2717 

1857 2195 

1858 I9I9 

1859 1840 
i860 1476 

1861 1848 

1862 3673 

1863 2871 

1864 3782 

1865 3217 

1866 2688 

1867 2184 

1868 2468 

From this it will appear that every great annual rise in the 
London deaths from " fever," since the last great typhus epidemic 



155 


138 


130 


137 


68 


234 


204 


140 


408 


212 


337 


228 


342 


217 


1062 


149 


274 


214 


15 


180 


48 


176 


25 


95 


86 


161 


1827 


220 


1309 


174 


2493 


253 


1950 


523 


1760 


582 


1396 


380 


1964 


459 



214 TypJms and other Continued Fevers. 

of 1847-48, has corresponded to a greatly increased admission, 
not of enteric cases, but of typhus cases into the London Fever 
Hospital. On the other hand, enteric fever has been at a some- 
what steady or endemic level for a good many years. Even at 
that level it would have had a small share of the whole fever- 
mortality in the old London ; in modern London, especially in 
its residential quarters, its rate has probably been higher than in 
former times ; while in recent years, owing to the absolute decline 
of typhus, it has been by far the most common continued fever. 
If the conditions were the same in London as in Edinburgh, it 
was the very creation of residential streets and new quarters of 
the town that called forth typhoid fever ; while the more the 
town was remodelled, the more were the fomites of typhus 
destroyed. Thus it seems probable that the same progress 
in well-being among all classes, which has gradually brought 
typhus down almost to extinction (or apparently so for the 
present), has been attended with an increase of typhoid, an 
increase which has happily fallen within the last few years from 
its highest point. 

The disappearance, during the last twenty years, of typhus 
and relapsing fevers from the observation of all but a few 
medical practitioners in England, Scotland and Ireland, is one 
of the most certain and most striking facts in our epidemiology. 
Most of the recent English cases have occurred in Lancashire, 
especially in Liverpool, and in Sunderland, Gateshead, New- 
castle and other shipping places of the north. In the decennial 
period 1871-80 the death-rate from typhus, per lOOO living, was 
0*58 in Liverpool and 0'33 in Sunderland, rates which were about 
the same as those from enteric fevers. The rates in 1881-83 
were also high in the same group of towns. As to other indus- 
trial centres, including the coal-districts of Cumberland, Wales 
and Scotland, it is probable that a good deal of typhus passes 
under the name of " typhoid," the change in medical fashion 
having outrun somewhat the real change in the relative preva- 
lence of each fever\ In Scotland the disease is still heard of 
from time to time in Glasgow, Edinburgh, Leith, Dundee, 
Aberdeen, Inverness and Thurso. In London the recent im- 
munity from it is remarkable, but intelligible. First, the popu- 
lace is better housed : we have got rid of the window-tax, 

1 Spear, "Typhus P^ever in various parts of England, 1886-87." ^'^'^'P- ^^<-'^^- OJJ. 
Loc. Gov. Bd. N. S. XVI. p. 169. 



Causes of the decline of Typhtts. 215 

rebuilt the houses in regular streets opening upon wide 
thoroughfares, pulled down most of the back-to-back houses, 
dispersed the working population over square miles of suburbs 
easily accessible from the heart of the town by tramways and 
railways, perfected the sewerage and the water-supply. These 
great structural changes are so far an earnest that typhus cannot 
come back in the old way. Secondly, food has been for a long 
time cheap and wages good. During the remarkable lull in 
typhus from 1803 to 18 16, Bateman pointed out that the un- 
wholesome state of the dwellings of the working class remained 
the same as before, but that money was flowing freely among 
all classes (thanks to the special war-expenditure). Under free 
trade, the same abundance of the necessaries of life has been 
secured in another way. Typhus, it need hardly be said, is an 
indigenous or autochthonous infection ; the conditions of its en- 
gendering are never very far off. In a small and remote island 
off the coast of Skye, which I happened to know in its pleasing 
aspects from having landed upon it during a summer vacation, 
typhus fever was reported by the newspapers a few months after 
to have broken out in the hamlet of twenty or thirty families, 
the winter storms having prevented the fishers from leaving 
their cottages or any stranger from approaching the island. 
In a sparsely populated parish of the east coast of Scotland, 
two cases of genuine typhus (one of them fatal), and two only, 
have occurred, to medical knowledge, within the last ten years, 
each in a very poor cottage in a different part of the parish and 
in a different season. So long as our cheap supplies of food, fuel 
and clothing are uninterrupted, there is small chance of typhus 
or relapsing fever. But the population of England being now 
twice as great as the home-grown corn can feed, a return of those 
fevers on the great scale is not out of the question in the event 
of the foreign food-supply being interfered with, or the neces- 
saries of life becoming permanently dearer from any other cause. 
The following Table of the fever-deaths in Scotland since 
the beginning of Registration does not distinguish enteric from 
typhus, relapsing and simple continued during the first ten 
years of the period ; but it is probable, from all that is known 
non-statistically or by hospital figures only, as to the history of 
enteric fever in Scotland, that it made the smaller part of the 
generic total of fever-deaths so long as typhus and relapsing 
fevers were common. 



2l6 



Typhus and other Cojithmed Fevers. 



Scotland — Deaths from the Co7itimied Fevers since the 
beginning of Registration. 



Year 














185s 


2419 ^ 












1856 


2363 












1857 


3087 












1858 


2790 












1859 


2436 


Inclusive 


of typhus, 


relapsing, 


enteric 




i860 


2344 


and other continued fevers. 






1861 


2579 












1862 


3021 












1863 


3441 












1864 


4804 1; 






Simple 


Infantile 


Cerebro 




Typhus 


Enteric 


Relapsing 


continued 


Remittent 


Spinal 


1865 


3272 


1048 


62 


839 


164 





1866 


2172 


1404 


34 


249 


159 


— 


1867 


1745 


1378 


40 


105 


119 


— 


1868 


I561 


1404 


45 


100 


132 





1869 


2059 


1335 


29 


121 


157 


— 


1870 


1460 


1207 


205 


151 


141 





1871 


1 129 


1234 


411 


108 


124 


— 


1872 


795 


1223 


115 


103 


. 118 


— 


1873 


628 


1495 


31 


192 


117 


— 


1874 


726 


1455 


27 


104 


80 


— 


1875 


61S 


1625 


17 


98 


85 


— 


1876 


471 


1448 


18 


65 . 


88 


— 


1877 


265 


1427 


5 


164 


— 


— 


1878 


263 


1477 


2 


147 


— 


— 


1879 


210 


IOI3 


5 


133 


■ — 





1880 


170 


1338 


4 


155 


— 





1881 


229 


1004 





IIS 


— 


— 


1882 


180 


1204 


2 


90 


— 





1883 


152 


998 


I 


71 


— 


7 


1884 


138 


1050 


2 


63 


— 


9 


1885 


III 


889 


I 


58 


— 


8 


1886 


80 


755 


2 


62 


— 


10 


1887 


126 


835 


7 


65 


— 


4 


1888 


102 


66s 


6 


58 


— 


6 


1889 


69 


795 


I 


45 


■ — 


2 


i8go 


77 


777 


— 


30 


— 


3 


1891 


107 


799 


4 


23 


— 


6 



Circumstances of Enteric Fever. 

The circumstances of typhus and relapsing fevers need no 
general stating after what has been said of particular epidemics 
in England and Scotland, or remains to be said, for the most 
distinctive instances of all, in the chapter on fevers in Ireland. 
There has been so little typhus in the country at large since the 

1 '2303 f)f lliese fever deaths in 1864 occiu'rcd in the eight principal towns of 
Scotland, classified as follows : typhus, 1450, relapsing fever, 371, gastric, enteric, or 
tyi)hoid, 382. 



Enteric Fever as a seasonal infection. 217 

disease began to be registered apart in the mortality returns, 
in 1869, that hardly anything can be inferred except the fact of 
its disappearance. It is significant, however, that Sunderland, 
one of the two great towns which have kept typhus longest and 
in largest measure (Liverpool being the other) is distinguished 
for the overcrowding of its dwelling-houses (7"24 persons to a 
house in the Census of 1881, 7'00 in the Census of 1891). 

But the circumstances of enteric fever are not only not so 
obvious as those of typhus in the historical way ; they are also 
more complex and disputable. One fact in the natural history 
of enteric fever has been made clear in the chronology, namely, 
its greater frequency after a severe drought. It was in the 
autumn of 1826, after the driest and hottest summer of the 
century, that cases of fever with ulceration of the bowel were 
first described and figured in London. It was in the autumn of 
1846, after the next very dry and hot summer, that cases of the 
same fever again became unusually common in many parts of 
England and Scotland. The same sequence has been remarked 
on more recent occasions and in various countries. It is ex- 
plained by taking into account some other facts in the natural 
history of enteric fever. In nearly all countries in our latitudes, 
autumn is its principal season, and autumn is the season when 
the level of the water in the soil, or in the wells, is lowest. 
Virchow states the law of enteric fever in the following simple 
and concrete way : " We [in Berlin] have a certain number of 
cases of typhoid at all times. The number increases when the 
sub-soil water falls, and decreases when it rises. Every year, at 
the time of the lowest level of the sub-soil water, we have a 
small epidemic." A sharp rise above the mean level of the 
year, from the first week of September to the end of October, 
has been well shown for London from the admissions to the 
hospitals of the Metropolitan Asylums Board, 1 875-1 884. The 
curve has an equally sharp descent, passing below the mean 
line of the year in the second week of December^ There are 
indications that it is the partial filling of the pores of the 
sub-soil with water, after they have long been occupied with 
air only, that makes the virus of typhoid active, or, in other 

^ G. B. Longstaff, M.D., Trans. Epid. Soc. 1884-5, p. 72, reprinted in his Studies 
in Statistics, Lond. 1891, p. 402. The seasonal curve for the typhoid admissions to 
the London Fever Hospital over a longer period is nearly the same, as well as that of 
the registered deaths by typhoid in all London, 1869-84. 



2l8 



TypJius and other Continued Fevers. 



words, that the rains of late summer and autumn are the occa- 
sion of the seasonal increase of the infection. 

Yet it is not the changes in the ground-water by themselves, 
just as it is not rainfall and temperature by themselves, that 
make enteric fever to prevail. The soil in which those vicissi- 
tudes of drought and saturation are potent for evil must be one 
that is befouled with animal organic matters, more especially with 
excremental matters. For that and other reasons (such as the 
geological formation), enteric fever shows, in its more steady or 
endemic prevalence from year to year or from decade to decade, 
certain marked preferences of locality. Since 1869, when the 
deaths from it began to be registered apart, it has been much 
more common, per head of the population, in the quick-growing 
manufacturing and mining towns than in any other parts of 
England and Wales, the districts with highest enteric death-rates 
being the mining region of the East Coast from the mouth of 
the Tees to somewhat north of the Tyne, the mining region of 
Glamorgan, certain manufacturing towns of Lancashire and the 
West Riding of Yorkshire, and some districts in the valley of 
the Trent in Staffordshire and Nottinghamshire. The following 
Table shows, by comparison with all England and Wales and 
with London, the excessive death-rates from enteric fever in the 
registration divisions which head the list : 



Highest moj'talities from Enteric Fever in Registration Divisions 
of England and Wales^. 



Decennium 1871 — 80 


Decennium 

1881—90 




Annual death- 
rate, all causes 
per 1000 living 


Annual death- 
rate, Enteric, 
per 1000 living 


Enteric Deaths 
in 10 years 


Deaths, 

Enteric, in 

10 years 


England and Wales 
London 


21-27 
22-37 


0-32 
0-24 


78421 
8536 


53509 

7497 


Durham co. 
South Wales 
■ W. Ridinjr, Yorks. 
N. Riding, Yorks. 
Nottinghamshire 
Lancashire 


23-77 
21-09 
23-24 
19-68 
21-23 
25-17 


0-56 
0-45 
0-45 
0-44 

0-43 
0-39 


4525 
3715 
9166 
1259 
1707 
12388 


2590 
2550 
5170 
896 
1263 
9874 



^ The following large registration districts besides those in the Table, liad enteric- 
fever death rates of -5 and upwards per 1000 persons living, in the ten years 1871-80; 
in nearly all of them there has been a marked decline in the ten years 1881-90: — 



m 



Endemic seats of Enteric Fever. 



219 



Durham Minins: Districts. 



Stockton incl. part of 

Middlesborough (4I 

years) 
Stockton (5^ years) 
Guisborough, incl. part 

of Middlesborough 

(4f years) 
Guisborough (5J years) 
Middlesborough ^ 

(51 years) 



Auckland 



Pontypridd^ 
Merthyr Tydvil 
Swansea 
Llanelly 



26-64 

22'4Q 



24-80 
20-45 

I9'93 
24-52 



rog 
0-62 



1-17 
0-38 

0-63 

0-71 



561 

208 

(5I years) 

251 
71 

272 

(5I years) 

541 



South Wales Mining Districts. 

23-16 
24-23 
22-38 
20-93 



0-71 


515 


0-62 


639 


0-63 


50s 


0-83 


330 



106 

460 

318 



541 
249 

387 
165 



In the second decennium of the Table, 1881-90, the total 
deaths from enteric fever (the death-rates are still unpublished) 
are much below those of 1871-80. All the counties of England 
and Wales have shared in that notable decline, including Durham 
and Glamorgan. But these two great districts of the coal and 
iron mining are, by the latest returns, still keeping the lead ; and 
it is probable that we shall find in them, or in particular towns 
within them, the conditions that have been most favourable to 
enteric fever in the earlier decennia of this century and are still 
favourable to it. First it is to be observed that one of the most 
noted of the old typhoid centres in Glamorgan, namely Merthyr 
Tydvil, has ceased to be in that class; its enormous rate of 
growth has been checked (to i8'9 per cent, from 1881 to 1891) 
and it has at the same time become a more uniform and better- 
ordered municipality. 

Durham, Hartlepool, Easington, Houghton-le-Spring, Darlington, Gateshead (county 
Durham); Morpeth (Northumberland); Aysgarth, Todmorden, Dewsbury, Ponte- 
fract, Barnsley, Rotherham (Yorkshire); Dudley, Leigh, Ormskirk (Lancashire); 
Crickhowell (Wales) ; Worksop, Radford (Nottingham) ; Shrewsbury ; Peterborough ; 
Portsea Island (Hants). Of the London districts, Hackney had the highest enteric 
fever, 0-46 per 1000 in a general death-rate of 20-78. The high rate of a decennium 
is not unfrequently brought up by one great explosion. In many of the Lancashire, 
Yorkshire and Midland towns, with rates about -4 per 1000 persons, the rate has been 
somewhat steady from year to year. In the decennium 1871-80, many special 
outbreaks, some of them in villages, were reported on by the inspectors of the 
Medical Department, and traced for the most part to water-supplies tainted by the 
percolation of excrement. 

^ The Registration District of Middlesborough was carved out of Stockton and 
Guisborough in 1875. 

^ Registration District containing a population of 72,707 on a mean between the 
Census of 187 1 and that of 188 r. In 1891 the population was 146,812. 



220 TyphiLS and other Contiimed Fevers. 

On the other hand, on the same river Taff, and in the 
tributary valley of the Rhondda, there is an immense popu- 
lation of miners, among whom the enteric fever death-rate 
will probably be found to have been higher in 1881-90 than 
in any other registration district. The most populous part of 
the district is the town of Ystradyfodwg, which had 44,046 
inhabitants in 1881 and 68,720 in 1 891, an increase of over 
fifty per cent., the highest urban rate of increase in the country. 
On the mean of the last three years, 1891-93, its enteric fever 
death-rate has been '62 per 1000, There are several populous 
towns or townships in the mining districts of the north-east 
which have in like manner kept their high rate of typhoid 
mortality — Auckland, Easington, Bellington (Morpeth) and 
Middlesborough. It is held by many that enteric fever has 
been most characteristically a product of the modern system 
of closet-pipes and sewers. It is, of course, the defects of the 
system that are, in this hypothesis, to blame, including its 
partial adoption, the transition-state from the older system, 
the tardy extension to new streets, as well as cheap and faulty 
construction. All those things, together with the inherent 
difficulty of connecting with a main sewerage the irregular 
squattings of a mining community, are probably to be found 
in highest degree in those districts of Durham and South Wales 
that are most subject to enteric fever. While enteric fever is 
in some places steady or endemic from year to year, in others 
its force is felt mostly in great and sudden explosions. 

One such happened in the city and district of Bangor in the summer 
of 1882. The registration district had only 95 deaths from enteric fever in 
the ten years 1871-80, but in the single year 1882 it had 87 deaths registered 
under that name. Of 548 attacks (with 42 deaths) which were known from 
22 May to 12 September, 407 fell in August and the first twelve days of 
September 1. In the following year and throughout the rest of the decen- 
nium the district had its usual low average of enteric-fever deaths. One 
thing relevant to the explosion was probably the excessive rainfall of June 
and July (9'5 inches, as compared with 4'8 inches about London). 

Another explosion, probably unique in the history of enteric fever, took 
place at Worthing, on the Sussex coast, in the summer of 1893. The 
enteric death-rate of the town had been much below the average of England 
and Wales from 1871 to 1880, the rate being 0-15 per 1000 and the whole 
deaths in ten years 36. During the next ten years, 1881-90, the whole 
cnlcric deaths were 43 in the entire i-egistration district (population in 1891, 

' F. W. Bany, M.D., in Rep. Med. Off. Loc. Gov. Board for 1882, p. 72. The 
contention of the inspector was that the water-supply had been tainted by enteric- 
fever evacuations from a case which began on 22 May in a cottage some half-mile 
distant from the reservoir but in communication with it through ditches and brooks. 
The area of the water-supply did not correspond with the area of the fever. 



Remarkable explosions of Enteric Fever. 221 

32,394). In 1 89 1 the typhoid deaths were two, in 1892 they were six. In 
1893 a severe outbreak of typhoid took place within the municipal borough 
(population 16,606): In the first quarter of the year Worthing was one of 
the places mentioned for typhoid, having had 5 deaths ; in April there were 
no deaths, in May 25, in June 19, in July 61, in August 64, in September 11, 
and in the last quarter of the year 8, making 193 deaths in the year. The 
highest weekly number of cases notified was 253 in the second week of July. 
The enormously wide dispersion of the poison, in a town Uttle subject to 
enteric fever, caused suspicion to fall on the water-supply, the more reason- 
ably that the district of West Worthing, which had a separate water-supply, 
was said not to have suffered from the outbreak. A new water-supply was 
at once undertaken. A relief fund of £7000 was raised for the sufferers. 

The towns of Middlesborough, Stockton and Darlington, in the lower 
valley of the Tees, were together the scene of two remarkable explosions of 
enteric fever, the first from 7 September to 18 October, 1890, the second 
from 28 December, 1890, to 7 February, 1891. The phenomenal nature 
of these outbreaks in the autumn and winter of 1890-91 will appear from the 
following table of deaths by enteric fever : 

Darlington Stockton Middlesborough 

Ten years 1881-90 104 258 460 

1890 21 66 130 

1891 17 59 93 

In the first of the two explosions the three towns were almost equally 
attacked per head of their populations; in the second explosion, in mid-winter, 
Darlington had relatively only half as many cases as each of the other two, 
which had about the same number of cases as in the former six-weeks' 
period. In both periods, of six weeks each, the three towns had together 
1334 cases of typhoid, while the country districts near them had a mere 
sprinkling. A flooded state of the Tees appeared to be a relevant antecedent 
to each of the explosions. The Tees is a broad shallow river flowing 
rapidly, subject to frequent inundations, tortuous in its lower course, forming 
at its mouth, where Middlesborough stands, a wide estuary bordered by low 
flat grounds. The rainfall at Middlesborough was 6*3 inches in August, of 
which 2 "2 inches fell on the 12th of the month, the river being high in flood 
thereafter. There were again high floods in November, chiefly caused by the 
melting of snow in the upper basin (5 inches fell at Barnard Castle in 
November, 3'i inches at Middlesborough, while the December fall was i'2 
inches at the former and i'4 inches at the latter). To apply correctly the 
ground-water doctrine of enteric fever to these explosions, other particulars 
would have to be known, more especially the extent of the previous dryness 
of the subsoil (the rainfall at Middlesborough was 9*3 inches in the first half 
of 1890, 1 5 '6 in the second half, and below average for the whole year). But 
the flooded state of the Tees valley in August and November must have 
changed abruptly the state of the ground-ferments within the areas of the re- 
spective towns and so afforded, according to the general law, the conditions 
for an abrupt increase of enteric fever in these its endemic or perennial soils ^ 

^ The report for the Medical Department by F. W. Barry, M.D. {Enie7-ic Fever in 

the Tees Valley, 1890-91, Pari, papers, Nov. 1893), is an elaborate argument to prove 

|i that the flooded state of the Tees was indeed the relevant antecedent, not as indexing 

1 the rise of the ground-water in the respective towns, but as dislodging and sweeping 

! down the slops, sewage and dry refuse of the market town of Barnard Castle, in upper 

i Teesdale, whereby the water taken in from the Tees two miles above Darlington to 

I the tanks, filters and reservoirs of the Darlington Corporation, and of the Stockton 

and Middlesborough Water Board, was tainted in some unusual degree — a hypothesis 

I the more remarkable that the refuse, such as it was, had been suspended or dissolved 

in an unusiial volume of water, that little refuse could have collected between the 



222 TypJms and other Contimced Fevers. 

While the more or less steady or endemic prevalence of 
typhoid fever is due to the formation and reproduction in the 
soil of an infective principle (probably of faecal origin) which 
affects more or less sporadically the individuals living thereon, 
after the manner of a miasma rising from the ground, there have 
been some hardly disputable instances of the infection being 
conveyed to many at once from a single source in the drinking 
water and by the medium of milk\ But such instances, sugges- 
tive though they be and easy of apprehension by the laity, must 
not be understood as giving the rule for the bulk of enteric 
fever. In like manner, the escape or reflux of excremental 
gases from pipes or sewers, or the leakage into basements or 
foundations from faulty plumber-work, are causes, real no doubt, 
but of limited application, which do not conflict with, as they do 
not supersede, the more comprehensive and cognate explanation 
of enteric fever as an infection having its habitat in the soil and 
an incidence upon individuals after the manner of other mias- 
matic infections. Sex has little or nothing to do with the 
incidence of the infective virus. As to age, enteric fever rarely 
befalls infants, and, in the general belief of practitioners, is a less 
frequent cause of death among children than among adolescents 
and adults. 

In the following Table from the Registrar- General's Decennial Review, 
1871-80, enteric fever is not separated from other continued fevers. It is 
probable that a considerable ratio of the deaths from o to 5 years are due to 
febrile disorders other than enteric. 

Annual Mortality per million living at all ages and at eleven groups of 
ages, males and females, from fever {including Typhus, Enteric Fever 
and Different Forms of Continued Fever) 1871-80. 
All 



ages 


— 


5— 


10— 


15— 


20— 


25— 


35— 


45— 


55— 


65- 


75 + 


Both sexes 484 
Males 494 
Females 477 


651 
644 
658 


518 
483 
550 


439 
390 
487 


543 
513 
S73 


509 
579 
445 


411 
436 
387 


379 
395 
362 


402 
437 
369 


458 

503 
418 


553 
629 
488 


498 

593 

425 



first floods and the second, and that no cases of enteric fever were known in the upper 
valley of the Tees. This judicial deliverance has not been accepted by the authorities 
of Darlington, Stockton and Middlesborough, nor by the Royal Commission on Water 
Supply, before whom it was laid. 

^ Besides the epidemic at Worthing in 1893, which is still sub judicc, the best 
known instance of typhoid following a certain water-supply is the explosion at 
Redhill and Caterham in Jan. — Feb. 1879, Rep. Rlcd. Off. Loc. Gov. Board, for 1879, 
Pari, papers, 1880, p. 78. The first instance alleged of the distribution by milk was 
the Islington explosion in July — August 1870 (Ballard, Med. Times and Gaz. 1870, 
II. 611). It was soon followed by the Maiylebone explosion in the summer of 1873 
(/vV/. Med. Off. L. G. B., N.s. 11. 193) ; but such instances have become less common, 
while instances of scarlatina and diphtheria following a milk-supply have become 
more common. 



Incidence of Enteric Fever on individuals. 223 

The cases notified under the Act in 1891 and 1892 have been 
found to average five or six for every death registered in the 
corresponding districts, the rate of fatality ranging widely. It 
is matter of familiar knowledge that many of the attacks and 
fatalities occur among the richer classes. New comers to an 
endemic seat of the disease are most apt to take it (this has been 
elaborately shown for Munich, and holds good for the British 
troops in India). There are undoubtedly constitutional pro- 
clivities to it among individuals, which may run strongly in 
families. As in other miasmatic infective diseases, such as 
yellow fever, Asiatic cholera, and (formerly) plague, there seem 
to be occasions in the varying states of body and mind, as well 
as in the external circumstances, when the infection of enteric 
fever is specially apt to find a lodgement and to become effective. 
The old plague-books gave lists of the things that were apt to 
invite venom or to stir venom (see former volume pp. 212, 674) ; 
and it is probable that some of these hold good also for the 
incidence of enteric fever. 



CHAPTER II. 



FEVER AND DYSENTERY IN IRELAND. 

The history of the pubHc health in Ireland has been so 
remarkable that it may be useful to take a continuous view of it 
in a chapter apart, so far as concerns flux, or dysentery, and 
typhus with relapsing fever. 

Ireland is a country which would have given Hume, had he 
thought of it, the best of all his illustrations of the difficult 
problem handled in the essay " Of National Characters " — how 
far the habits, customs, temperaments and, he might have 
added, morbid infections have been determined by climate, and 
how far by laws and government, by revolutions in public 
affairs, or by the situation of the nation with regard to its 
neighbours. Not only is there something special and peculiar 
in the actual epidemiology of Ireland, but its political and social 
history has been apt to borrow the phrases of medicine in a 
figure. " First the physicians are to take care," says Burke, 
" that they do nothing to irritate this epidemical distemper. It 
is a foolish thing to have the better of the patient in a dispute. 
The complaint, or its cause, ought to be 'removed, and wise and 
lenient arts ought to precede the measures of vigour\" And 
this singular use of the imagery of disease in Irish history might 
be illustrated from many other passages of the same orator and 
essayist, just as it may be seen any day in the columns of 
newspapers in our own time. Giraldus Cambrensis began it, 
within a few years of the first English conquest of Irish 
territory by Henry II. Writing of that singular effect upon the 
English settlers by contact with the native Irish, whereby they 

^ Sccoml Letter to Sir Jlereiiles Laiii^rishe, May, l^^)^• 



The ''country disease'' and the " ag7ie" of Ireland. 225 

became, in the words of another medieval author, ipsis Hibernis 
hiber7tiores, he resorts to the medical figure of " contagion " as 
the best way to account for it. So again, to overleap six 
centuries, Bishop Berkeley in his query "whether idleness be the 
mother or daughter of spleen \" is trying upon the Irish both 
Hume's problem of national character and the use of the 
medical figure. And, to take a modern instance. Lord Beacons- 
field used the same figure of the old humoral pathology, and 
gave his adhesion to a theory of national characters adverse to 
the sense of Hume, when he ascribed the habits and manners 
of the Irish, and the course of their national history, to their 
propinquity to a "melancholy" ocean. 

As far back as we can go in the history, two diseases are 
conspicuous — the flux or " the country disease," and the sharp 
fever or " Irish ague." When Henry II. invaded Ireland in 
1 1 72, his army suffered from flux, which the contemporary 
chronicler, Radulphus de Diceto, dean of St Paul's, set down to 
the unwonted eating of fresh meat {recentinm esus carninm), the 
drinking of water, and the want of breads Less than a 
generation after, Giraldus of Wales wrote his "Topography of 
Ireland," wherein he remarks that hardly any stranger, on his 
first coming to the country, escapes the flux by reason of the 
juicy food {ob Jiinnida nutrinientaY. At that time Ireland was 
almost wholly a pastoral country, and a pastoral country it has 
remained to a far greater extent than England or Scotland. It 
is to this comparative want of tillage, an almost absolute want 
when Giraldus was there, that we shall probably have to look 
in the last resort for an explanation of the two national 
maladies that here concern us — the " country disease " and the 
" Irish ague." The same dietetic reason that the dean of 
St Paul's gave in 1 172 for the prevalence of flux in the army of 
Henry II., the want of bread and the eating of fresh meat, can 
be assigned for the country disease long after, and, in some 
periods, on the explicit testimony of observers. As to the Irish 
ague, or typhus fever, Giraldus mentions it in the medieval 
period ; and Higden, copying him exactly, says : " The in- 
habitants of Ireland are vexed by no kind of fever except the 

^ Berkeley's Querist, Q. 362. 

- Radulphus de Diceto, Imag. Hislor. Eng. Hist. Soc. ed. i. 350. 

^ " Topogr. Hiberniae" in Opera, Rolls ed. v. 67. This and the preceding reference 
had escaped the notice of Dr John O'Brien, in the historical introduction to his 
' Observations on the Acute and Chronic Dysentery of Ireland. Dublin, 1822. 

c. II. 15 



226 Fever mid Dysentery in Ireland. . 

acute, and that seldom " — the word aciita being the original of 
"the ague," or, as in another translation of the passage, "the 
sharp axes\" In this pastoral country, according to Giraldus, 
there was little sickness and little need of physicians ; but there 
is hardly an instance of military operations by the English 
unattended with sickness among the troops, and famine with 
sickness among the native Irish. 

The generalities of Fynes Moryson, a traveller of the time 
of James I., who included Ireland among the many countries 
that he visited and described, throw light upon the dietetic 
peculiarities of the Irish. Having little agriculture, and at 
that time no general cultivation of the potato (although they 
adopted it much sooner ■ than the English and Scots), they 
lived, says Moryson, mostly on milk (as Giraldus Cambrensis 
also records in the twelfth century), and upon the flesh of 
unfed calves, which they cooked and ate in a barbarous fashion. 
" The country disease " is also noted. The experience in Ireland 
from time immemorial, that a bellyful was a windfall, must have 
been the origin of a habit observed by Moryson : 

" I have known some of these Irish footemen serving in England to lay 
meate aside for many meales to devoure it all at one time." And again : 
" The wilde Irish in time of greatest peace impute covetousnesse and base 
birth to him that hath any corne after Christmas, as if it were a point of 
nobility to consume all within these festivall dayes." The Irish slovenliness 
or filthiness in their food, raiment and lodging was apt, he says, " to infect" 
the English who came to reside in their country 2. 

About a generation after we come to the earliest medical 
account of the sicknesses of Ireland, by Gerard Boate, compiled 
during the Cromwellian occupation ^ The following occurs 
under the head of The Looseness : 

^ Polychronicon, Rolls ed. i. 332-3. 

2 " Many of the English-Irish have by little and little been infected with the Irish 
filthinesse, and that in the very cities, excepting Dublin and some of the better sort in 
Waterford, where the English continually lodging in their houses, they more retain 
the English diet." And again : " In like sort the degenerated citizens are somewhat 
infected with the Irish filthinesse, as well in lowsie beds, foule sheetes, and all linnen, 
as in many other particulars... Touching the meere or wild Irish, it may truely be said 
of them, which was of old spoken of the Germans, namely, that they wander slovenly 
and naked, and lodge in the same house (if it may be called a house) with their 
beasts." Fynes Moryson, Ilinerary, Pt. iv. p. 180. 

■' Ireland's Natural History, ^c. Written by Gerard Boate, late Doctor of 
Physick to the State in Ireland. And now published by Samuel Hartlib, Esquire. 

Lond. 1652. The author died at Dublin, shortly after his arrival there, on — January 

16=—. His information would seem to have come in part from his brother Arnold 

49 
Boate, resident in Ireland, 



Boate on the "country disease" and "ague''' 1650. 227 

The English have given it the name of the Country Disease. The subjects 
of it are often troubled a great while, but take no great harm. It is easily 
cured by good medicines : " But they that let the looseness take its course 

do commonly after some days get the bleeding with it ; and last it useth 

to turn to the bloody flux, the which in some persons having lasted a great 
while, leaveth them of itself; but in far the greatest number is very danger- 
ous, and killeth the most part of the sick, except they be carefully assisted 
with good remedies." 

The other reigning disease is the " Irish Ague," a continued 

fever of the nature of typhus : 

"As Ireland is subject to most diseases in common with other countries, 
so there are some whereunto it is peculiarly obnoxious, being at all times so 
rife there that they may justly be reputed for Ireland endeviii jiiorbi, or 
reigning diseases, as indeed they are generally reputed for such. Of this 
number is a certain sort of malignant feavers, vulgarly in Ireland called 
Irish agues, because that at all times they are so common in Ireland, as well 
among the inhabitants and the natives, as among those who are newly come 
thither from other countries. This feaver, commonly accompanied with a 
great pain in the head and in all the bones, great weakness, drought, loss of all 
manner of appetite, and want of sleep, and for the most part idleness or 
raving, and restlessness or tossings, but no very great nor constant heat, is 
hard to be cured." If blood-letting be avoided and cordial remedies given, 
" very few persons do lose their lives, except when some extraordinary and 
pestilent mahgnity cometh to it, as it befalleth in some years." Those who 
recover " are forced to keep their beds a long time in extreme weakness, being 
a great while before they can recover their perfect health and strength." 

The occasion of Boate's writing was the subjugation of 
Ireland by Cromwell, in the course of which we hear from time 
to time of sickness. The greatest of the calamities was the utter 
destruction of the prosperity of Galway by the frightful plague 
of 1649-50, and by the suppression of the Catholics, who had 
brought the port of Connaught to be a place of foreign 
commerced 

Cromwell's troops in 1649 incurred dysentery through the 
hardships of campaigning. On 17 September, 1649, the Lord 
General writes from Dublin to Mr Speaker Lenthall after the 
storming of Tredah or Drogheda : " We keep the field much ; 
our tents sheltering us from the wet and cold. But yet the 
country-sickness overtakes many : and therefore we desire 
recruits, and some fresh regiments of foot, may be sent us." 
And on 25 October, " Colonel Horton is dead of the country- 
diseased" 

^ Hardiman, History of Galway, p. 126 seq. The plague from July 1649 to Lady 
Day 1650 is said to have swept away 3700 of the inhabitants, including 210 of the 
most respectable burgesses and freemen, with their families. The capitulation on 
5 April, 1652, was followed by famine throughout the country, and by a revival of 
plague for two years, "during which upwards of one-third of the population of the 
province was swept away." 

^ Cromweirs Letters and Speeches, 11. 55, 77. 

15—2 



228 Fever and Dysentery in Ireland. 

Another general reference to the " country disease" of Ireland, 
by Borlase, is very nearly the same as Boate's. It is introduced 
early in the history, on the occasion of the death in 1591 of 
Walter, Earl of Essex, earl marshal of Ireland : 

" The dysentery, or flux, so fatal to this worthy person, is commonly 
termed the country disease ; and well it may, for it reigns nowhere so 
epidemically as in Ireland; tainting strangers as well as natives. But 
whether it proceeds from the peculiar disposition of the air, errour in diet, the 
laxity and waterishness of the meat, or some occult cause, no venomous 
creature living there to suck that which may be thought (in other countries) 
well distributed amongst reptilious animals, I shall not determine, though 
each of these circumstances may well conduce to its strength and vigour. 
Certain it is that regular diet preserves most from the violence, and many 
from the infection of this disease ; yet as that which is thought very 
soveraign — I must say that the stronger cordial liquors (viz. brandy, usquebeh, 
treacle and Mithridate waters) are very proper, or the electuaries themselves, 
and the Hkei." 

From the Restoration to the Revolution little is known of 
epidemics in Ireland.' It is probable that Dublin and the other 
considerable towns fared much the same as English towns. A 
Dublin physician writing to Robert Boyle on 27 February, 1682, 
speaks of a petechial fever, marked by leaping of the tendons, 
which had been fatal to very many in that city for these twelve 
or fourteen months^. With the Revolution the troubles of the 
country begin again, and enter on their peculiarly modern 
phase. For our history, two characteristic incidents come at the 
very beginning of the new period of disorder among the Irish — 
the sicknesses of the siege of Londonderry and the unparalleled 
havoc of disease among the troops of Schomberg in the camp 
of Dundalk. In both, the old "country disease," which had 
affected Cromwell's troops, was the primary malady, occurring, 
of course, in circumstances special enough to have bred it 
anywhere ; in both, the dysentery was attended or followed by 
typhus fever, the old "Irish ague;" and although the epidemics 
of Londonderry and Dundalk in 1689 are properly examples of 
war sickness, yet the circumstances of each may help to realize 
the connexion between dysentery and typhus in the ordinary 
history of the Irish. 

^ Edmund Borlase, History of the Rahidion of Ireland to the Croimi of England. 
1675, p. 172. 

'^ Boyle's Works., fol. Lend. 1744, v. 92. 



Sicknesses of the siege of Londonderry , 1689. 229 



Dysentery and Fever at Londonderry and 
Dundalk, i68g. 

The siege of Londonderry^ by the Catholic Irish army of 
James II. began in April and ended on 28 July, having lasted 
105 days. On 19 April the garrison numbered 7020 men, and 
the total of men, women and children in the town was estimated 
at 30,000, a number which included refugees from the neighbour- 
ing country and would have been more but for many Protestants 
at the beginning of the siege leaving the city and taking " pro- 
tection " at the hands of the besiegers. On 21 May, a collection 
was made for the poor, who began to be in want. Sickness is 
heard of on 5 June, when several that were sick were killed in 
their beds by the enemy's bombs. The dread of the bombs in the 
houses caused the people to lie about the walls or in places 
remote from the houses all night, so that many of them, especially 
the women and children, caught cold, which along with the 
want of rest and failing food, threw them into fluxes and fevers. 
The pinch of hunger began to be felt before the middle of June, 
about which time and for six weeks after the fluxes and fevers 
were rife. A great mortality spread through the garrison as 
well as the inhabitants ; fifteen captains and lieutenants died in 
one day, and it was estimated that ten thousand died during 
the siege, " besides those who died soon after." The want, the 
dysentery, the fever and the vast numbers of dead every day 
must have produced a horrible state of things ; when, on 2 July, 
five hundred useless persons were put outside the walls, to 
disperse as they best could, the besiegers are said to have 
recognized them when they met them " by the smell." 

^ The war-pestilence at Londonderry in 1689 is the third recorded epidemic of the 
kind there, not inckiding what may have happened in the capture of the town by the 
Catholics in O'Neill's rebellion, when Derry was destroyed, to be rebuilt in 161 3 by 
the London Companies with a new charter under the name of Londonderry. The 
first historical occasion of sickness was in 1566. The troops of Elizabeth were 
landed on Loch Foyle in October and built their huts on the site of the old 
monastery. In the course of the winter the greater part of a force of 11 00 men 
perished by dysentery and the infection which it breeds (see former volume, p. 372). 
On 12 Dec. 1642, a year after the outbreak of the Rebellion of Confederate Catholics, 
a petition of the agents of the distressed city of Londonderry to the Commons 
represented that there were 6059 persons in the city, whereof 5123 were women and 
children, or sick, aged or impotent ; only 2000 were inhabitants of the city, the rest 
having fled there for safety. Spotted fever had broken out. {Hist. MSS. Comis. v. 
- "MSS. of the House of Lords.") 



230 Fever and Dysentery in Ireland. 

About the middle of June large quantities of provisions were 
found in cellars and places of concealment under ground ; after 
that the garrison had always bread, although the allowance 
was small. An ingenious man discovered how to make pan- 
cakes of starch and tallow, of which articles there was no lack ; 
the pancakes not only proved nutritious, but are said to have 
been an infallible cure of the flux, or preservative from it. At 
length, on 28 July some of the victuallers and ships of war 
which had been in Lough Foyle since the 15th of June, sailed up 
to the head of the Lough on the evening flood tide, finding little 
resistance from the enemy's batteries and none from " what was 
left of" the tide-tossed boom of logs across the mouth of the 
river. Provisions poured in, and the siege was raised ; but it is 
clear that the infection continued for some time after, having 
been found among such of the released garrison as repaired to 
Schomberg's camp at Dundalk. 

The Catholic army is said (by the Protestants) to have lost 
8000 or 9000 before the walls of Londonderry, " most by the 
sword, the rest of fever and flux, and the French pox, which 
was very remarkable on the bodies of several of the dead officers 
and soldiers^" 

Not far off, at Dundalk, there began, a few weeks after, an 
extraordinary outbreak of war-sickness, which, unlike the pes- 
tilence in Londonderry, was altogether inglorious in its circum- 
stances. In many respects it resembled the disaster to Cromwell's 
troops at the first occupying of Jamaica in 1655-56^; but it was 
worse than that, and it is probably unexampled in the military 
annals of Britain ^ 

Supplies had been voted in Parliament for quelling the 
Catholic rebellion in Ireland, and an expedition was got together 
under the illustrious Marshal, Duke of Schomberg. The force 
consisted of some ten thousand foot, most of them raw levies 
from the English peasantry, with one regiment of seasoned 

^ With the exception of the last quoted piece of information, the most minute 
particulars of the siege of Londonderry are in an essay by an army chaplain, John 
Mackenzie, A Narrative of the Siege of Londonderry, London, 1690, which was 
written to correct and augment A True Account of the Siege of Londonderry by the 
Rev. Mr George Walker, rector of Donoghmoore in the county of Tyrone, and late 
Governor of Derry. London, 1689. 

" See former volume, pp. 634-43. 

^ Minute particulars of it are given in An Linpartial History of the IVars in 
Ireland [1689-1692]. By George Story, Cliaplain to Sir Thomas Gower's Regiment. 
London, 1693. Part 1. 



Camp sickness at Dundalk, 1689. 23 1 

Dutch troops ("the blue Dutch"), and cavalry. While the bulk 
of the force was undisciplined, their clothes, food, tents and other 
munitions of war were bad or insufficient through the fraud of 
contractors. The expedition embarked at Hoylake on the Dee 
and landed on the 15th of August, 1689, nearly three weeks 
after the relief of Londonderry, at Bangor, on the south side of 
Belfast Lough. Schomberg took Carrickfergus, and began to 
advance on Dublin ; but finding the towns burned and the 
country turned into a desert, he threw himself into an entrenched 
camp around the head of Dundalk Bay, nearly a mile from the 
town of Dundalk. His camp was on a low moist bottom at 
the foot of the hills. The Irish Catholic army took up a position 
among the hills " on high sound ground," not more than two 
miles distant from the English lines, and, being in superior force, 
in due time they offered battle, which was declined. Schomberg, 
who had been joined by the Enniskillen regiments of dragoons 
and by men from Londonderry, had under him some 2000 horse 
and not less than 12,000 foot at the time when James II. offered 
battle. The undisciplined state of his English troops and the 
suspected treachery of a body of French Protestants were among 
the causes that held Schomberg back ; but he had to reckon 
also with sickness almost from the moment of sitting down at 
Dundalk. At a muster on 25 September, several of the regi- 
ments were grown thin " by reason of the distemper then 
beginning to seize our men." The distemper was dysentery 
and fever. The two maladies were mixed up, as they usually 
are in war and famines, the flux commonly preceding the fever, 
and perhaps affording the virulent matters in the soil and in the 
air upon which the epidemic prevalence of the fever depends. 
It was easy to account for the dysentery among the troops at 
Dundalk ; but as to the fever, there was an ambiguity at the 
outset which Story is careful to note : " And yet I cannot but 
think that the feaver was partly brought to our camp by some 
of those people that came from Derry; for it was observable 
that after some of them were come amongst us, it was presently 
spread over the whole army, yet I did not find many of them- 
selves died of it." Where the cause of death is specially named, 
it is fever, as in the cases of Sir Thomas Gower, Colonel Wharton 
and other officers on the 28th and 29th October. The fever 
was a most malignant form of typhus, marked by the worst of 
' all symptoms, gangrene of the extremities, so that the toes or a 



232 Fever and Dysentery in Ireland. 

whole foot would fall off when the surgeon was applying a 
dressing\ 

It seems probable that most of the enormous mortality was 
caused by infection, and not by dysentery due to primary 
exciting causes. 

The primary exciting causes were obvious, but seemingly 
irremovable. Schomberg had a great military reputation, but 
he was now over eighty, and it does not appear that he made 
himself personally felt in the camp, although he issued inces- 
santly orders to inspect and report. As the mortality proceeded 
apace during the six or eight weeks of inactivity, murmurings 
arose against the commander. He was unfortunate in his choice 
of a camping ground, and in an unusually cold and wet season. 
The newly raised English troops seem to have been lacking 
equally in intelligence and in moral qualities. Their foul lan- 
guage and debauchery were the occasion of a special proclama- 
tion ; their laziness and inability to make themselves comfortable 
called forth numerous orders, but all to no purpose. The 
regiment of Dutch troops were so well hutted that not above 
eleven of them died in the whole campaign ; but the English 
would not be troubled to gather fern or anything else to keep 
themselves dry and clean withal : " many of them, when they 
were dead, were incredibly lousy." 

The camping ground not only received the drainage of the 
hills, but, strange to say, the rain would be falling there all day 
while the camp of the enemy, only a few miles farther inland, 
would not be getting a drop. On i October the tents on the 
low ground were moved a little higher up. On the same date 
there were distributed among the regiments casks of brandy — 
Macaulay says it was of bad quality — which appears to have 
been the trusted remedy against camp sickness, as in the 
Jamaica expedition of 1655. There were twenty-seven vic- 
tuallers or other ships riding in Dundalk Bay ; but the stores 
were bad, and the regimental surgeons had come unprovided 
with drugs that might have been useful in flux or fever. While 
the weather continued cold and wet, there was also a scarcity of 
firing and forage. On 14 October all the regimental surgeons 
were ordered to meet at ten in the morning to consult with 

' Gangrene of the extremities was one of the symptoms of the " plague of Athens" 
as described by Thucydides. There is no need to invoke ergotism for an explanation 
of it, as some have done. 



TJie mortality among tJie troops in Ulster, 1689. 233 

Dr Lawrence how to check the sickness \ Several officers 
having died on the i6th and 17th, the camp was shifted on the 
20th to new ground, the huts being left full of the sick. Gower's 
regiment had sixty-seven men unable to march, besides a good 
many dead before or sent away sick. Story, the chaplain, went 
every day from the new camp to visit the sick of his regiment 
in the huts, and always at his going found some dead. He 
found the survivors in a state of brutal callousness, utterly in- 
different to each other, but objecting to part with their dead 
comrades as they wanted the bodies to sit or lie on, or to 
keep off the cold wind. The ships at anchor had now received 
as many sick as they could hold, and the deaths on board soon 
became as many as on shore. On 25-27 October, the camp was 
again shifted, but the sickness continued apace. At length on 
3 November, the Catholic army having dispersed to winter 
quarters, the sick were ordered to be removed to Carlingford 
and Newry. " The poor men were brought down from all 
places towards the Bridge End, and several of them died by 
the way. The rest were put upon waggons, which was the 
most lamentable sight in the world, for all the rodes from 
Dundalk to Newry and Carlingford were next day full of 
nothing but dead men, who, even as the waggons joulted, some 
of them died and were thrown off as fast." Some sixteen or 
seventeen hundred had been left dead at Dundalk. The ships 
were ordered to sail for Belfast with the first wind, and the 
camp was broken up. There was snow on the hills and rain 
in the valleys ; on the march to Newry, men fell out of the 
ranks and died at the road side. When the ships weighed 
anchor from Dundalk and Carlingford, they had 1970 sick men 
on board, but not more than iioo of these came ashore in 
Belfast Lough, the rest having died at sea in coming round 
the coast of County Down. Such was the violence of the infection 
on board that several ships had all the men in them dead and 
nobody to look after them whilst they lay in the bay at Carrick- 
fergus. An infective principle, once engendered in circumstances 

^ At that time there was little systematic knowledge of military hygiene. Nearly 
two generations after, the experiences of Pringle, Donald Monro and Brocklesby in 
the campaigns of 1743-48 and 1758-63 in Germany and the Netherlands, yielded 
many valuable hints, some of which Virchowmade use of in compiling his "Rules of 
Health for the Army in the Field," in the Franco-Prussian War of 1870-71. See his 
Gesainmelte Abhattdlimgen aiis de>/i Gebiete der offentlicheii Medicin und Seuchenlehre. 
2 Bde. Berlin, 1879, '^- 193- 



234 Fever and Dysentery in Ireland. 

of aggravation such as these, is not soon extinguished. Belfast 
was the winter quarters, and in the great hospital there from 
I November, 1689, to i May, 1690, there died 3762, "as appears 
by the tallies given in by the men that buried them." These 
numbers together make fully six thousand deaths, which agrees 
with the general statement that Schomberg lost one half of the 
men whom he had embarked at Hoylake in August. The Irish 
Catholic army began to sicken in their camp in the hills above 
Dundalk Bay just before they broke up, and they are said to 
have lost heavily by sickness in their winter quarters. 

The war ended with the Treaty of Limerick, in 169 1. The 
Seven 111 Years followed, — ill years to Scotland, in a measure 
to England, and almost certainly to Ireland also ; but it does 
not appear that the end of the 17th century was a time of 
special sickness and famine to the Irish, and it may be inferred 
from the fact of Scots migrating to Ireland during the ill years 
that the distress was not so sharp there. The epidemiology of 
Ireland is, indeed, a blank until we come to the writings of 
Dr Rogers, of Cork, in some respects the best epidemiologist 
of his time, which cover the period from 1708 to 1734. His 
account of the dysentery and typhus of the chief city of Munster 
in the beginning of the i8th century will show that the old 
dietetic errors of the Irish, noted in medieval times, had hardly 
changed in the course of centuries. 

A generation of Fevers in Cork. 

Rogers is clear that typhus fever was never extinct, while 
the three several times when it " made its appearance amongst us 
in a very signal manner," are the same as its seasons in England, 
namely 1708-10, 1718-21 and 1728-30^ His experience relates 
only to the city of Cork, and, so far as his clinical histories go, 
only to the well-to-do classes therein ; and although those 
seasons were years of scarcity and distress all over Ireland, yet 
Rogers does not seem to associate insufficient food with the 
fever, and never mentions scarcity. The fevers were in the 
winter, for the most part, and were usually accompanied by 
epidemic smallpox of a bad type, which in 1708 "swept away 
multitudes." Nothing is said of dysentery for the earliest of the 

' Joseph Rogers, M.D. Essay on Epidemic Diseases. Dublin, 17.54. 



Rogers on the fevers of Cork, 1708-31. 235 

three fever-periods; but for 1718 and following years we read 
that "dysentery of a very malignant sort, frequently producing 
mortification in the bowels," prevailed during the same space ; 
and that the winters of the third fever-period, namely, those of 
1728, 1729 and 1730 were "infamous for bloody fluxes of the 
worst kind," It is clear that the fever spread to the richer 
classes in Cork, for his five clinical histories are all from those 
classes. The following is his general account of the symptoms : 

The patient is suddenly seized with sHght horrors or rather chilliness, to 
which succeed a glowing warmth, a weight and fixed pain in the head, just 
over the eyebrows ; soreness all over his tlesh, as if bruised, the liinbs heavy, 
the heart oppressed, the breathing laboured, the pulse not much altered, but 
in some slower; the urine mostly crude, pale and limpid, at first, or even 
throughout, the tongue moist and not very white at first, afterwards drier, 
but rarely black. An universal petechial effioresence not unlike the measles 
paints the whole surface of the body, limbs, and sometimes the very face ; in 
some few appear interspersed eruptions exactly like the picstulae viiliares, 
filled with a limpid serum. The earlier these petechiae appear, the fresher m 
colour, and the longer they continue out, the better (p. 5). The fixed pain 
in the head increasing, ends commonly in a coma or stupor, or in a deliiium 
with some. Some few have had haemorrhage at the nose, a severe cough, 
and sore throat. In some he had observed a great tendency to sweats, even 
from the beginning : these are colliquative and symptomatic, not to be 
encouraged. In but few there have appeared purple and livid spots, as in 
haemorrhagic smallpox: some as large as a vetch, others not bigger than a 
middling pin's head, thick set all over the breast, back and sometimes the 
limbs, the pulse m these cases being much below normal. The extremities 
cold from the 6th or 7th day, delirium constant, tongue dry and black, urine 
limpid and crude, oppression greater, and difficulty of breathing more. It is 
a slow nervous fever (p. 18). 

Rogers believed that mere atmospheric changes could not be 
the cause of these epidemics : " they may favour, encourage and 
propagate such diseases when once begun ; but for the productive 
cause of them we must have recourse to such morbid effluvia 
as above described [particles of all kinds detached from the 
animal, vegetable and mineral kingdoms] ; or resolve all into 
the Qelov tL so often appealed to by Hippocrates^" 

But, as regards Cork itself, special interest attaches to the 
following " four concurring causes : " 

"ist, the great quantities of filth, ordure and animal off'als that crowd our 
streets, and particularly the close confined alleys and lanes, at the very 
season that our endemial epidemics rage amongst us. 

^ In further illustration of the power of morbid efifluvia, he says: "We see how 
small a portion of a putrid animal juice, taken into the blood by inoculation, like a 
most active leaven sets all in a ferment ; and in a very short time brings the whole 
juices of a sound body into an equal state of corruption with itself," — instancing 
war-typhus, plague from cadaveric corruption (according to Pare), the Oxfoi'd gaol 
fever, and " a later instance at Taunton not more than five or six years ago." 



236 Fever and Dysentery in Ireland. 

2nd, the great number of slaughter-houses, both in the north and south 
suburbs, especially on the north ridge of hills, where are vast pits for 
containing the putrefying blood and ordure, which discharge by the de- 
clivities of those hills, upon great rains, their fetid contents into the river, 

3rd, the unwholesome, foul, I had almost said corrupted water that great 
numbers of the inhabitants are necessitated to use during the dry months of 
the summer. 

4th, the vast quantities of animal offals used by the meaner sort, during 
the slaughtering seasons : which occasion still more mischief by the quick 
andsudden transition from a diet of another kind." 

In farther explanation of the fourth concurring cause, he says 
that in no part of the earth is a greater quantity of flesh meat 
consumed than in Cork by all sorts of people during the 
slaughtering season — one of the chief industries of the place being 
the export of barrelled beef for the navy and mercantile marine. 
The meat, he says, is plentiful and cheap, and tempts the poorer 
sort " to riot in this luxurious diet," the sudden change from a 
meagre diet, with the want of bread and of fermented liquors, 
being injurious to them\ 



Famine and Fevers in Ireland in 1718 and 1728. 

Thus far Rogers, for the city of Cork in the three epidemic 
periods, 1708-10, 171 8-21, and 1728-30, two of which, if not 
all three, were periods of dysentery as well as of typhus. But 
it was usual in Ireland for the country districts and small towns 
to suffer equally with the cities. The circumstances of the Irish 
peasantry in the very severe winter of 1708-9 are not particularly 
known ; if there was famine with famine-fever, it was not such 
as to have become historical. But for the next fever-period, 
1718-20, we have some particulars. Bishop Nicholson, of 
Derry, writes : " Never did I behold even in Picardy, Westphalia 
or Scotland, such dismal marks of hunger and want as appeared 

^ Dr Rogan of Strabane, in his Condition of the Middle and Lower Classes in the 
North of Ireland, 1819, was of a different opinion (p. 90) : "No police regulations 
exist in Strabane to prevent the slaughtering of cattle in any part of the town. The 
butchers, therefore, most of whom live in the narrow streets near the shambles, have 
their slaughter-houses immediately behind their dwellings. The garbage is thrown 
into a large pit, which is generally cleaned but once in the year, at the season when 
the manure is required for planting potatoes, and at this time an offensive smell 
pervades the whole town, and is perceptil)le for a considerable distance around. The 
families exposed constantly to tlie effluvia arising from these heaps of putrid offal 
miglit have been expected to suffer severely from fever ; but on the contrary, they 
were found to be much less liable to it than others in the same rank of life. This 
was no douljt owing to their living chiefly on animal food, and thus escaping tlie 
debility induced by deficient nourishment, which certainly had tlie chief share in 
creating a predisposition to tlie disease." 



State of the Irish peasantry, ly 26-28. 237 

in the countenances of most of the poor creatures I met with 
on the road." One of the bishop's carriage horses having been 
accidentally killed, it was at once surrounded by fifty or sixty 
famished cottagers struggling desperately to obtain a morsel 
of flesh for themselves and their children^. 

This was a time when the population was increasing, but 
agriculture, so far from increasing in proportion to the number 
of mouths to feed, was positively declining, unless it were the 
culture of the potato. In a pamphlet of about 1724, on 
promoting agriculture and employing the poor, the complaint is 
of beef and mutton everywhere, and an insufficiency of corn. 
" Such a want of policy," says one, " is there, in Dublin especially, 
on the most important affair of bread, without a plenty of which 
the poor must starve." Another, a Protestant, has the following 
threat for the clergymen of the Established Church : " I'll 
immediately stock one part of my land with bullocks, and the 
other with potatoes — so farewell tithes'-^!" From this it is to 
be inferred that potatoes were not made tithable until a later 
period, pasture being exempted to the last. For whatever 
reason, grazing, and not corn-growing, was then more general in 
Ireland than in the generations immediately preceding, much 
land having gone out of tillage. The culture of the potato was 
driven out of the fertile lowlands to the hill-sides, so as to leave 
the ground clear for ranges of pasture. Rack-renting was the 
rule, doubtless owing to the same reason as afterwards, the 
competition for farms. While the Protestants emigrated in 
thousands, the Catholics multiplied at home in beggary. A 
pamphleteer of 1727 says: "Where the plough has no work, 
one family can do the business of fifty, and you may send away 
the other forty-nine." Thus we find the pasturing of cattle 
preferred to agriculture long after the barbaric or uncivilized 
period had passed, preferred indeed by English landlords or 
farmers^ 

There were three bad harvests in succession, 1726, 1727 
and 1728, culminating in a famine in the latter year. Boulter, 
archbishop of Armagh, who then ruled Ireland, was able to 
buy oats or oatmeal in the south and west so as to sell it below 

- Bp. Nicholson to Archbp. of Canterbury, cited by Lecky (li. 216) from Brif. 
Mus. ^dd. AfS. 6116. 

- Cited by O'Rourke, History of the Great Irish Fatrtine ofi^^']. Dublin, 1875, 
I , from pamphlet in the Halliday Collection of the Royal Irish Academy. 

^ See Boulter's Letters to the English Ministers. 



238 Fevei^ and Dysentery in Ireland. 

the market price to the starving Protestants of Ulster, an 
interference with the distribution of food which led to serious 
rioting in Cork, Limerick, Clonmel and Waterford in the first 
months of 1728^ No full accounts of the epidemic fever of that 
famine remain. Rutty, of Dublin, says it was " mild and 
deceitful in its' first attack, attended with a depressed pulse, and 
frequently with petechiae";" while, according to Rogers and 
O'ConnelP, the epidemic fever of Munster was the same. Of 
the famine itself we have a glimpse or two. Primate Boulter 
writes to the Duke of Newcastle on 7 March, 1727 : 

" Last year the dearness of corn was such that thousands of families 
quitted their habitations to seek bread elsewhere, and many hundreds 
perished ; this year the poor had consumed their potatoes, which is their 
winter subsistence, near two months sooner than ordinary, and are already, 
through the dearness of corn, in that want that in some places they begin 
already to quit their habitations*." 

Quitting their habitations to beg was a regular thing at a 
later time of the year. It was in the course of these bad 
years, in 1729, that Swift wrote his ' Modest Proposal for 
preventing the Children of Poor People in Ireland from being 
a Burden to their Parents or Country,' The scheme to use 
the tender babes as delicate morsels of food for the rich, was 
a somewhat extreme flight of irony, not so finished as in Swift's 
other satires, but the circumstances out of which the proposal 
grew were more real than usual, 

" It is a melancholy object," says the Dean of St Patrick's, " to those who 
walk through this great town, or travel in the country, when they see the 
streets, the roads and cabin doors crowded with beggars of the female sex 
followed by three, four, or six children, all in rags, and importuning every 
passenger for an alms." Having ventilated his project for the children, he 
proceeds to show that "their elders are every day dying and rotting by cold 
and famine, filth and vermin, as fast as can be reasonably expected," 

All the while there was a considerable export of corn from 
Ireland. In the beginning of 1730, two ships laden with barley 
were stopped at Drogheda by a fierce mob and were compelled 
to unload °. 

The interval between those years of epidemic typhus in 

1 Wakefield's Ireland, li. 6, cited by Barker and Cheyne. 

-John Rutty, M.D. Chronological History of the Weather and Seasons and 
prevailing Diseases in Dublin during Forty Years, London, 1770. 

■' Maurice O'Connell, M.D. Morboruin acittoruvi et chronicorum Observatioties. 
Dublin, 1746. 

* 'Qo\\\\.ers Letters. Oxford, 1769, i. 226. 

^ Lecky, n. 217. 



Berkeley on the economic paradoxes of Ireland. 239 

Ireland and the next, 1740-41, was filled, we may be sure, with 
at least an average amount of the endemial fever. Rutty 
specially mentions it in Dublin in the autumn and winter of 
1734-35 : "We had the low fever, called nervous (and sometimes 
petechial from the spots that frequently attended, although 
probably not essential)." He then adds : " It is no new thing 
with us for this low kind of fever to prevail in the winter 
season ; " and gives figures from the Dublin Bills of Mortality 
for forty years. He mentions the petechial fever as being 
frequent next in January and February, 1736, corresponding 
to a bad time of it in Huxham's Plymouth annals. In 1738 
and 1739 the type of the Dublin fever was relapsing, in part at 
least, the same type having been seen at Edinburgh shortly 
before. 

The economics of Ireland, at this time, gave occasion to 
Berkeley's Querist, a series of weekly essays written in 1737 
and 1738, and collected in 1740, on the eve of the next 
great famine and mortality^ A few of the bishop's sarcasms, 
in the form of queries, will serve to show how anomalous was 
the economic condition of the country, and how easily a crisis 
of famine and pestilence could arise. 

" 169. Whether it is possible the country should be well improved while 
our beef is exported, and our labourers live upon potatoes '^. 

" 173. Whether the quantities of beef, butter, wool and leather, exported 
from this island, can be reckoned the superfluities of a country, where there 
are so many natives naked and famished ? 

" 174. Whether it would not be wise so to order our trade as to export 
manufactures rather than provisions, and of those such as employ most hands ? 

" 466. Whether our exports do not consist of such necessaries as other 
countries cannot well be without "i 

" 353- Whether hearty food and warm clothing would not enable and 
encourage the lower sort to labour ? 

" 354. Whether in such a soil as ours, if there was industry, there would 
be want? 

"418. Whether it be not a new spectacle under the sun, to behold in 
such a climate and such a soil, and under such a gentle government, so 
many roads untrodden, fields untilled, houses desolate, and hands unem- 
ployed ? 

"514. Whether the wisdom of the State should not wrestle with this 
hereditary disposition of our Tartars, and with a high hand introduce 
agriculture? 

" 534. Why we do not make tiles of our own, for flooring and roofing, 
rather than bring them from Holland ? 

'- "539- Whether it be not wonderful that with such pastures, and so 
many black cattle, we do not find ourselves in cheese?" 

1 Berkeley's Works. Ed. Fraser, Oxford, 1871, in. 369. 



240 ' Fever and Dysentery in Ireland. 

In several of his queries (381, 383) Bishop Berkeley is driving 
at the expediency of domestic slavery. It was two hundred 
years since the same expedient had been tried by Protector 
Somerset in England, during the intolerable state of vaga- 
bondage which followed the rage for pasture farming under the 
first Tudors. In Scotland, it was hardly more than a generation 
since the institution of domestic slavery had commended itself 
to Fletcher of Saltoun, as the only expedient that could free 
that country from the vagabondage of a tenth, or more, of the 
population. England had surmounted the difficulty long ago, 
Scotland got over it easily and speedily when she was admitted 
to the English and colonial markets for her linen manufacture 
by the Treaty of Unions But in Ireland in the year 1740, and 
until long after, disabilities of all kinds, not only economic, but 
political and religious, were fastened upon the weaker nation by 
the stronger, the unfortunate cause of their long continuance 
having been the costly inheritance of loyalty to James II. and 
the Mass. 

The Famine and Fever of 1740-41. 

At the time when the bishop of Cloyne was issuing his 
economic queries from week to week (not much to the satis- 
faction of Primate Boulter), things were making up for the 
greatest crisis of famine and pestilence that Ireland experienced 
in the i8th century. There had been relapsing fever among the 
poor in Dublin in the autumn of 1738, and it appeared among 
them again in the summer and autumn of 1739. Rutty's 
account of it is as follows : 

" It was attended with an intense pain in the head. It terminated some- 
times in four, for the most part in five or six days, sometimes in nine, and 
commonly in a critical sweat. It was far from being mortal. I was assured 
of seventy of the poorer sort at the same time in this fever, abandoned to the 
use of whey and God's good providence, who all recovered. The crisis, 
however, was very imperfect, for they were subject to relapses, even some- 
times to the third time, nor did their urine come to a complete separation." 

In October 1739, there appeared some dysenteries in Dublin. 

The winter of 1739 set in severely with cold and wet in 

November, and about Christmas there began a frost of many 

^ Lord John Russell used these historical parallels from England and Scotland in 
his great speech in the House of Commons, during the debate on Ireland, ■25th 
January, 1847. 



The causes of famine iji 1740. 241 

weeks' duration which was more intense than anyone remem- 
bered. It is said to have made the ground hke iron to the 
depth of nine inches ; the ice on all the rivers stopped the corn 
mills, trees and shrubs were destroyed, and even the wool fell 
out of the sheep's backs. In January 1740 the destitution was 
such that subscription-lists were opened in Dublin, Cork, 
Limerick, Waterford, Clonmel, Wexford and other places. 
Bishop Berkeley distributed every Monday morning twenty 
pounds sterling among the poor of Cloyne (near Cork) besides 
what they got from his kitchen. One morning he came down 
without powder on his wig, and all the domestics of the 
episcopal palace followed suit^ The distress became more 
acute as the spring advanced. The potato crop of 1739 had 
been ruined, not by disease as in 1845-46, but by the long and 
intense frost. It was usual at that time to leave the tubers in 
the ridges through most of the winter, with the earth heaped up 
around them. The frost of December found them with only 
that slight covering, and rotted them : " a dirissimo hoc et 
diuturno gelu penitus putrescebant," says Dr O'Connell. Besides 
putrid potatoes, the people ate the flesh of cattle which had died 
from the rigours of the season. Owing to the want of sound 
seed-potatoes, the crop of 1740 was almost a blank. The 
summer was excessively dry and hot. In Dublin, the price of 
provisions had doubled or trebled, and some of the poor had 
died of actual starvation. In July dysenteries became common, 
and extended to the richer classes in the capital. Smallpox 
was rife at the same time, and peculiarly fatal in Cork. Dysen- 
tery continued in Dublin throughout the autumn and winter of 
1740 (the latter being again frosty), and became the prevailing 
malady elsewhere. 

On 8 February, 1741, Berkeley writes that the bloody flux 
had appeared lately in the town of Cloyne, having made great 
progress before that date in other parts of the country. A week 
after he writes (15 Feb.), " Our weather is grown fine and warm : 
but the bloody flux has increased in this neighbourhood, and 
raged most violently in other parts of this and the adjacent 
counties V This prevalence of dysentery, and not of fever, as 
the reigning malady of the winter of 1740-41 in Munster is 

1 Fraser, " Life and Letters of Berkeley," in Works, iv. 262. 
^ Berkeley to Prior, P'eb. 8 and 15, i74x- 

C. IL 16 



242 Fever and Dysentery in Ireland. 

confirmed by Dr Maurice O'Connell, who says that the typhus 
of the previous summer gave place to it. Dysentery in the 
winter and spring, preceding the fever of summer, was also the 
experience in the famine of 18 17. Berkeley treated the subjects 
of dysentery, not with tar water, but with a spoonful of 
powdered resin dissolved in oil by heat and mixed in a clyster 
of broth'. 

As the year 1741 proceeded, with great drought in April and 
May, typhus fever (which had appeared the autumn before) and 
dysentery were both widely epidemic, so that it is impossible to 
say which form of disease caused most deaths. In Dublin 
during the month of March, 1741, the deaths from dysentery 
reached a maximum of twenty-one in a week, " though it was 
less mortal than in the country, to which the better care taken 
of the poor and of their food undoubtedly contributed." Bishop 
Berkeley writes on the 19th of May : 

" The distresses of the sick and poor are endless. The havoc of mankind 
in the counties of Cork, Limerick and some adjacent places, hath been 
incredible. The nation probably will not recover this loss in a century. 
The other day I heard one from county Limerick say that whole villages 
were entirely depeopled. About two months since I heard Sir Richard Cox 
say that five hundred were dead in the parish where he lives, though in 
a country I believe not very populous. It were to be wished that people of 
condition were at their seats in the country during these calamitous times, 
which might provide relief and employment for the poor^." 

It was said that there were twenty-five cases of fever in the 
bishop's own household, which were cured by the panacea, 
tar-water, drunk copiously — a large glass, milk-warm, every 
hour in bed, the same method being practised by several of his 
poor neighbours with equal success*. In a " Letter from a 
country gentleman in the Province of Munster to his Grace the 
Lord Primate*" it is said : 

" By a moderate computation, very near one-third of the poor cottiers of 
Munster have perished by fevers, fluxes and downright want... The charity of 
the landlords and farmers is almost quite exhausted. Multitudes have 
perished, and are daily perishing, under hedges and ditches, some by fevers, 
some by fluxes, and some through downright cruel want in the utmost 
agonies of despair. I have seen the labourer endeavouring to work at his 
spade, but fainting for want of food," etc. 

^ He published the receipt in a Dublin journal. 

^ Berkeley to Thomas Prior, in "Life and Letters," u. s., p. 265. Some attempts at 
relief-works had been made tlie year l^efore, two of which are still to be seen in the 
obelisks on Killiney Hill near Dublin and on a hill near Mavnooth (" Lady Conolly's 
Folly." O'Rourke, u. s.). 

•' Rutty, p. 9:5. 

' (Dublin, I 741). 



The epidemic types in 1740-41, 243 

The loss of life must have been great also in Connaught. A 
letter of 8 July, 174J, from Gal way, says: "The fever so rages 
here that the physicians say it is more like a plague than a 
fever, and refuse to visit patients for any fee whatever\" The 
Gal way Assizes were held at Tuam^ the races also being 
transferred to the same neighbourhood, not without their usual 
evening accompaniments of balls and plays. 

Of this famine and sickness it might have been said, in the 
stock medieval phrase, that the living were hardly able to bury 
the dead I 

As in later Irish famines, there appear to have been, in 
1740-41, three main types of sickness — dysentery, relapsing 
fever and typhus fever. In Dublin, as we know from the direct 
testimony of Rutty, there was relapsing fever in 1739, before the 
distress had well begun, and again in the summer of 1741, when 
the worst was over. So much is said of dysentery that we may 
well set down to it, and to its attendant dropsy, a great part of 
the deaths, as in the famine of 1846-47. But it is probable that 
true typhus fever, sometimes of a malignant type, as at Galway, 
was the chief infection in 1741, which was the year of its great 
prevalence in England, It was characterized by a mild and 
deceitful onset, like a cold. Spots were not invariable or 
essential ; they were mostly of a dusky red, sometimes purple, 
and sometimes intermixed with miliary pustules, O'Connell 
mentions, for Munster, bleeding from the nose, a mottled rash as 
in measles, and pains like those of lumbago. One of the worst 
features of the Irish epidemic of 1740-41 was the prevalence of 
fever in the gaols. At Tralee above a hundred were tried, most 
of them for stealing the means of subsistence ; the gaol was so 
full that there was no room to lie down, and fifty prisoners died 

^ Cited by O'Rourke. Short, a contemporary, also says that the fever in Galway 
was like a plague. 

^ Button, Statistical Survey of the County of Galway. Dublin, 1824, p. 313 : 
"1741. A fever raged this year that occasioned the judges to hold the assizes in 
Tuam. Numbers of the merchants of Galway died this year, and multitudes of poor 
people, caused partly by fever and by the scarcity, as wheat was ^%s. per cwt." 

^ The author of The Groans of Ireland (Dublin, 1741) says : "On my return to 
this country I found it the most miserable scene of distress that I ever read of in 
history : want and misery in every face ; the rich unable to relieve the poor ; the 
road spread with dead and dying bodies ; mankind of the colour of the docks and 
nettles which they fed on ; two or three, sometimes more, on a car going to the grave 
for want of bearers to carry them, and many buried only in the fields and ditches 
where they perished." Skelton, a Protestant clergyman, says: "Whole parishes in 
some places were almost desolate ; the dead have been eaten in the fields by dogs, 
for want of people to bury them." Skelton's Works, Vol. v. Cited by Lecky. 

16 — 2 



244 Fever and Dysentery in Ireland. 

in six weeks. Limerick gaol had dysentery and fever among its 
inmates, and the judge who held the Munster Circuit died of 
fever on his return to Dublin \ 

Rutty says that the fever fell most upon strong middle-aged 
men, less upon women, and least of all upon children. The 
number of orphans was so great after the famine that Boulter, 
the Anglican primate, seized the opportunity to start the 
afterwards notorious Charter Schools for the education of the 
rising generation according to the Protestant creed. In all the 
subsequent Irish famines it was the enormous swarms of people 
begging at a distance from their own parishes that spread the 
infection of fever ; and there seems to have been as much of 
beggary in 1741, when Ireland was underpeopled with two 
millions, as in 18 17-18, when it was overpeopled with six 
millions. A few years after the famine, Berkeley wrote in 1749: 

" In every road the ragged ensigns of poverty are displayed; you often 
meet caravans of poor, whole families in a drove, without clothes to cover, or 
bread to feed them, both which might be easily procured by moderate 
labour. They are encouraged in their vagabond life by the miserable 
hospitality they meet with in every cottage, whose inhabitants expect the 
same kind reception in their turn when they become beggars themselves." 

The estimates of the Irish mortality in 1741 varied greatly, 
as they have done in the Irish famines of more recent times. 
One guessed a third of the cottiers of Munster, another said 
one-fifth ; and it is known that, whereas in Kerry the hearth- 
money was paid in 1733 by 14,346, it was paid in 1744 by only 
93721 The largest estimates are 200,000 deaths or even 
400,000 deaths in all Ireland in a population of less than two 
millions. But Dr Maurice O'Connell, who practised in Cork, 
and saw in Munster the mortality at its worst, estimated the 
deaths in all Ireland, in the two years 1740 and 1741, from 
fevers, fiuxes and absolute want, at 80,000. Those who saw the 
famine, fever and dysentery of 18 17-18 in a population increased 
by three times were inclined to doubt whether even the 
smallest estimate of 80,000 for 1740-41 was not too large; but 
it is clear that the famished and fever-stricken in the i8th 
century were in many places allowed to perish owing to the 

' Report by Dr Phipps to Baron Wainwright, lo March, 1741. Cited by F. C. 
Webb, Trans. Epidcm. Soc. 1857, p. 67. 

^ .Smith's Kerry, p. 77. He adds that many were excused the hearth-tax on 
account of their poverty, by certificate of the magistrates ; so that the decrease in 
1744 may mean a greater proportion excused the tax, as well as a depopulation. 



Relapsing and ''putrid'' fevers after 1740-41. 245 

indifference of the ruling class or the exhaustion of their means, 
so that a much higher rate of fatality may be assumed for that 
epidemic than for the first of the 19th century Irish famines. 

The distress came to an end before the winter of 1741, when 
food was so cheap in Dublin that a shilling bought twenty-one 
pounds of bread. The subsequent prevalence of typhus fever 
and dysentery in Ireland, whether epidemic or endemic, is very 
imperfectly known to the end of the century. It may be 
inferred that there was in that period no epidemic so great as 
that of 1740-41 ; but it is clear from the records kept by Rutty 
in Dublin down to 1764, and by Sims in Tyrone to 1772, that 
the indigenous fevers and fluxes of the country were never long 
absent, being more common in some years than in others'. 

The year 1744 was remarkable for a destructive throat 
distemper among children, described elsewhere, and the year 
1745 for smallpox dispersed by swarms of beggars. In 1746 
and 1748, the Dublin fever was relapsing in part, "terminating," 
says Rutty, "the fifth, sixth, seventh or eighth day with a 
critical sweat. A relapse commonly attended, which however 
was commonly carried off by a second critical sweat." In 1748, 
though the season was sickly, the diseases were not mortal, 
several of the fevers being " happily terminated by a sweat the 
fifth or sixth day." But there were also fevers of the low kind, 
sometimes with petechiae, sometimes with miliary pustules, 
though not essentially with either. In the autumn of 1754 
Rutty begins to adopt the language of the time concerning a 
" putrid " constitution, identifying the fever with the dangerous 
remittents which Fothergill was then writing about in London ; 
" it is probable that ours was akin to them and owing to the 
same general causes." In February, 1755, the fevers were fatal 
to many, raising the deaths to double the usual number; they 
attacked all ages, were of the low, depressed kind, and com- 
monly attended with miliary pustules. He again identifies 
them with the low, putrid fever in London. From that time on 
to 1758, Rutty has frequent references to the same fever, under 

^ How near the verge of want the people were is brought out by an experience in 
Galway county in 1745 : a great fall of snow smothered vast numbers of cattle and 
sheep, which caused a great many farmers to surrender their lands. Wheat rose 
from six to eighteen shillings the hundredweight, while, after the distress, the best 
land in Connaught could be rented for five shillings an acre. Button's Galway, 
P- 313- 



246 Fever and Dysentery in Ireland. 

the names of low, putrid, petechial and miliary. It was at its 
worst in 1757, and was marked by the remarkable tremors 
described by Johnstone at Kidderminster, as well as by miliary 
eruptions and by a gangrenous tendency at the spots where 
blisters had been applied. In November, 1757, it was fatal to 
not a few of the young and strong in Dublin, " and we received 
accounts of a like malignity attending this fever in the country^" 
It was still prevalent in the North and West of Ireland in the 
spring of 1758. He describes also an unusual amount of fever 
in the end of 1762. Sims, of Tyrone, an epidemiologist in the 
same manner as Rutty, does not begin his full annals until 
1765 ; but he sums up the years from 175 1 to 1760 as unhealthy 
by agues in spring, dysenteries and cholera morbus in autumn, 
and " low, putrid or nervous fevers throughout the year'^" He 
adds : 

"To the unhealthiness of these years the bad state and dearth of 
provisions might not a Httle contribute ; the poor, being incapable to procure 
sufficient sustenance, were often obliged to be contented with things at 
which nature almost revolted ; and even the wealthy could not by all their 
art and power render wholesome those fruits of the earth which had been 
damaged by an untoward season." 

Much of the distress, however, was owing to the continual 
spread of pasture-farming, which made the labour of villagers 
unnecessary''. 

The nearest approach to a great Irish epidemic in the second 
half of the i8th century was in 1 771, as described by Sims, 
the type of fever being clearly the same low, putrid or nervous 
fever, with offensive sweats and muscular tremors, that was 
commonly observed in England also in the middle third of the 
1 8th century. Early in the summer of 177 1 a fever began to 
appear which, as autumn advanced, raged with the greatest 
violence ; nor was it overcome by a severe winter. It claimed 
the prerogative of the plague, almost all others vanishing from 
before its presence. It began twelve months sooner in the 

1 For Kinsale, Cork and Bandon, see Marjoribanks, Med. Press ami Circ. i867,n.,S. 

" James Sims, M.D. Observations on Epidemic Disorders, ruith Remarks on 
Ner7)ous and Malignant Fevers. London, 1773, p. 10. The preface is dated from 
London, whither Sims had removed from Tyrone. He rose to eminence in the 
London profession. 

** A Letter to a Member of the Irish Parliament relative to the present State of 
Ireland. By Philo-Irene. London, 20 May, 1755. The turning of hundreds of 
acres into one dairy-farm liad caused the depopulation which Goldsmith described in 
the Deserted Village : '■ By this unliappy policy several villages have been deserted at 
different times by the inhabitants, and numbers of them set a-begging," p. 6. 



Sims on the epidemic fever of 1771. 247 

eastern parts of the kingdom, pursuing a regular course from 
East to West. Some symptoms suggest cerebro-spinal fever. 

The symptoms were languor, precordial oppression, want of appetite, 
slight nausea, pains in the head, back and loins, a thin bluish film on the 
tongue, turbid urine, eyes lifeless and dejected. After the fourth day, 
constant watchfulness, the eyes wild, melancholy, sometimes with bloody 
water in them, constant involuntary sighing, the tendons of the wrists 
tremulous, the pulse quick and weak, most profuse sweats, small dun petechiae 
principally at the bend of the arm and about the neck. At the height of the 
fever, on the ninth or tenth day, the tremulousness of the wrists spread to all 
the members, "insomuch that I have seen the bed-curtains dancing for three 
or four days to the no small terror of the superstitious attendants, who on 
first perceiving it, thought some evil spirits shook the bed. This agitation was 
so constant a concomitant of the fever as to be almost a distinguishing 
symptom." The patients lay grinding their teeth ; when awake, they would 
often convulsively bite off the edges of the vessel in which drink was given 
them. They knew no one, their delirium being incessant, low, muttering, 
their fingers picking the bed covering. The face was pale and sunk, the 
eyes hollow, the tongue and lips black and parched. Profuse clammy sweats 
flowed from them ; the urine was as if mixed with blood : the stools were 
involuntary. Petechiae almost black came out, having an outer circle with 
an inner dark speck ; sometimes there were the larger vibices. Bleedings at 
the nose were frequent. Those who were put to bed and sweated almost 
all died. Death took place about the 13th day. 

Curiously enough this disease showed itself even among the 
middle ranks of the people, especially those who lived an 
irregular life, used flesh diet and drank much. Among the 
poorer sort, who used vegetable food, the fever was more 
protracted and less malignant, but in the winter and spring it 
made much greater havoc among them. " Bleeding, that first 
and grand auxiliary of the physician in treating inflammatorj/ 
disorders, seemed here to lose much of its influence." It was, 
indeed, the long prevalence of this low or nervous type of fever 
in Britain and Ireland in the middle of the i8th century that 
drove blood-letting in fevers out of fashion until the return of a 
more inflammatory type (often relapsing fever) in the epidemic 
of 1 8 17. In 1770, while such fevers more or less nervous, 
putrid, miliary, were beginning to be prevalent among the 
adults, there was a good deal of " worm fever " among children. 
They suffered from heat, thirst, quick, full pulse, vomiting, coma, 
and sometimes slight convulsions, universal soreness to the touch, 
and a troublesome phlegmy cough. When not comatose they 
were peevish. The fever was remitting, the cheeks being highly 
flushed at its acme, pale in its remission. It lasted several days, 
but seldom over a week, nor was it often fatal. In children 
under five or six years, it could hardly be distinguished from 



248 Fever and Dysentery in Ireland. 

hydrocephalus internus\ The same association of the worm 
fever or remittent fever of children with the putrid or nervous 
fever of adults had been noticed at Edinburgh in 1735. Neither 
the fever of the adults nor that of the children will be found, on 
close scrutiny, to have had much in common with our modern 
enteric fever. 

The Epidemic Fevers of 1799-1801. 

Sims left Tyrone to practise as a physician in London, and 
with his departure what seems to have been the only con- 
temporary record of epidemics in Ireland ceased. The last 
quarter of the i8th century in Ireland had probably as much 
epidemic fever as in England ; but it is not until the years 
1 797-1 801 that we again hear of fever and dysentery, on the 
testimony of the records of the Army Medical Board, of the 
Dublin House of Industry, and of the Waterford Fever 
Hospital. At the end of the year 1796 the health of the 
regiments in Ireland was everywhere good ; but in December of 
that year, and in January 1797, the poor in the towns began to 
suffer more than usual from fever, and in the course of the year 
1797 fever appeared in several cantonments of troops — at 
Armagh as early as February or March, at Limerick, at 
Waterford and in Dublin I The summer and autumn were 
unusually wet, so that the peasantry of the southern and 
western counties were unable to lay in their usual supply of turf 
for fuel. In the course of the winter 1797-98 a considerable 
increase of fever and dysentery was remarked among them, and 
these two maladies appeared in various regiments in the early 
months of 1798. This was the year of the rebellion in the 
south-east of Ireland, pending the efforts for the union with 
England. The British troops were much engaged with the 
insurgents throughout the summer, and got rid in great part of 
the maladies of their quarters while they were campaigning. 
But in the end of the year fever began to spread, both among 
the inhabitants and among the troops. It was nothing new for 
English and Scots regiments to suffer from fever or dysentery 
during the greater part of their first year in Ireland ; but the 

1 Sims, u. s. pp. 164-5. 

^ F. Barker and J. Cheyne, .Iccoinii of the Fever lately epidemical in /reland. 
1 vols. London, i82r. This worlc relates mainly to the epidemic of 1817-19, but 
there is a short retrospect, the valuable part of which is for the years 1797-1802. 



The epidemic of 1 799-1801. 249 

epidemics in the end of 1798 were more than ordinary. The 
Buckinghamshire MiHtia quartered in the Palatine Square of 
the Royal barracks, Dubhn, lost by " malignant contagious 
fever" 13 men in October, 13 in November, and 15 in December. 
From November to January, the Warwick regiment suffered 
greatly in the same barrack. The Herefordshire regiment, 833 
strong, lost 47 men at Fermoy, mostly from fever contracted in 
bad barracks ; the Coldstream Guards at Limerick, the 92nd 
regiment at Athlone, and the Northamptonshire Fencibles at 
Carrick-on-Shannon, also lost men by fever. In July, 1799, not 
a single regiment in Ireland was sickly; but a wet and very cold 
autumn made a bad harvest, aggravating the distresses of the 
poor and causing much sickness, which the troops shared. The 
county of Wexford, the principal scene of the rebellion, suffered 
most, and next to it the adjacent county of Waterford. The 
fever-hospital of the latter town, the earliest in Ireland \ was 
projected in 1799; the statement made in the report of a plan 
for the new charity, that fifteen hundred dependent persons 
suffered from contagious fever every year there, showed that 
the need for it was nothing new, although hardly a tenth part of 
the number sought admission to the hospital when it was at 
work. Next year, 1800, the managers of the newly-opened 
hospital gave some particulars of the causes of fever in Water- 
ford — want of food, causing weakness of body and depression of 
mind, but above all the excessive pawning of clothes and 
bedding, whereby they suffered from cold and slept for warmth 
several in a bed. In the winter and spring of 1799-1800 the 
poor of Waterford had epidemic among them fever and dysen- 
tery, as well as smallpox. In Donagh-a-gow's Lane nine 
persons died of dysentery between October 1799 and March 
1800. The harvest of 1800 was again a failure, from cold and 
wet, bread and potatoes being dear and of bad quality. In the 
autumn and winter the distress, with the attendant fever and 
dysentery, became worse. At that time in Dublin all fever 
cases among the poor were received into the House of Industry 
(the Cork Street and Hardwick Hospitals were soon after built 
for fever-cases), at which the deaths for four years were as 
follows : 

^ The history of the Limerick and Belfast fever-hospitals is carried back to a few 
years before the founding of the Waterford hospital ; but the latter was the first that 
, was formally organised as a fever-hospital. 



:50 Fever and Dysentery in Ireland. 



Year 


Died in the Dublin 
House of Industry 


1799 
1800 
180I 
1802 


627 
I315 

1352 
384 


The enormous rise of the 


deaths in 1800 and 



1 80 1 shows 

how severe the epidemic of fever must have been. Compared 
with the epidemic of 18 17-18, it has few records, perhaps 
because the political changes of the union engrossed all atten- 
tion. But the significant fact remains that the deaths in the 
Dublin House of Industry in 1800 and 1801 were nearly as 
many as in all the special fever-hospitals of Dublin during the 
two years, i Sept. 1817 to i Sept. 18 19. At Cork, in 1800, 
there were 4000 cases of fever treated from the Dispensary ; at 
Limerick the state of matters is said to have been as bad as in 
the great famine of 1817-18; and there is some reason to think 
that the same might have been said of other places. All the 
relief in 1 800-1 801 came from private sources, the example of 
Dublin in opening soup-kitchens having been followed by other 
towns. The troops shared in the reigning diseases, especially 
at Belfast and Dublin ; in the latter city, the spotted fever was 
severe both among the military and all ranks of the civil 
population in August, 1801. The harvest of 1801 was abun- 
dant, and the fever quickly declined. It had been often of the 
relapsing type\ Dysentery appeared in the end of September, 
and became severe in many places in October and November, 
being attributed to the rains after a long tract of dry, hot 
weather. Ophthalmias and scarlatinal malignant sore-throats 
were common at the same time. 

The Growth of Population in Ireland. 

When the history of the great famine and epidemic 
sicknesses of 18 17- 18 was written, it was found that this 
calamity had fallen upon a population that had grown 
imperceptibly until it had reached the enormous figure of over 
six millions, the census of 1821 showing the inhabitants of 
Ireland to be 6,801,827. The increase from an estimated one 

1 "The fever in 1800 and i8or very generally terminated on the fifth or seventh 
day by perspiration ; the disease was then very lialile It) recur. The poor were the 
chief sufferers by it ; and it was much more fatal amongst the middling and upper 
classes in proportion to the number attacked." Barker and Cheyne, op. cit. p. 20. 



Growth of population in the \%th century. 251 

million and thirty-four thousand in 1695 was, according to 
Malthus, probably without parallel in Europe. According to 
Petty, the inhabitants in 1672 numbered about one million one 
hundred thousand, living in two hundred thousand houses, of 
which 160,000 were "wretched, nasty cabins without chimney, 
window or door-shut, and wholly unfit for making merchantable 
butter, cheese, or the manufacture of woollen, linen or leather." 
In 1695, the war on behalf of James II. having intervened, the 
population as estimated by South was 1,034,000. When the 
people were next counted in 173 1, by a not incorrect method 
in the hands of the magistracy and Protestant clergy, they were 
found to have almost doubled, the total being 2,010,221. This 
increase, the exactness of which depends naturally upon the 
accuracy of Petty 's and South's 17th century estimates, had 
been made notwithstanding the famines and epidemics of 17 18 
and 1728, and an excessive emigration, mostly of Protestants, 
to the West Indian and American colonies, which was itself 
attended by a great loss of life through disease. For the rest 
of the 1 8th century, the estimates of population are based upon 
the number of houses that paid the hearth-tax. In the following 
figures six persons are reckoned to each taxed hearth : 

Year Persons 

1754 2,372,634 

1767 2,544,276 

1777 2,690,556 

1785 2,845,932 

The hearth-money was not altogether a safe basis of reckoning, 
for the reason that many were excused it on account of their 
poverty by certificate from the magistrates, and that hamlets in 
the hills, perhaps those which held their lands in rungale or 
joint-lease, often compounded with the collectors for a fixed 
sum ; so that cabins might multiply and no more hearth-tax 
be paid\ It is probable that a considerable increase had taken 
place which was not represented in the books of the tax- 
collectors ; for in 1788, only three years from the last date 
given, the number of hearths suddenly leapt up to the round 
figure of 650,000 (from 474,322), giving a population of 3,900,000, 
at the rate of six persons to a cabin or house. But it is 
undoubted that a new impulse was given to population in the 
last twenty years of the i8th century, firstly by the bounties on 

^ Smith's Kerry. Dublin, 1756, p. 77. 



252 Fever and Dysentery in Ireland. 

Irish corn exported, dating from 1780, which caused much 
grazing land to be brought under the plough, and secondly 
by the gradual removal, after 1791, of various penalties and 
disabilities which had rested on the Roman Catholics since 
the reign of Anne, affecting their tenure of land, and serving 
in various ways to repress the multiplication of families. 
Accordingly we find the hearths rated in 1791 at the number 
of 701,102, equal to a population of 4,206,612. The estimates 
or enumxCrations from 1788, to the census of 1831, show an 
increase as follows : 

Year Persons Year Persons 



1788 3,900,000 

1 79 1 4,206,612 

1805 5,395,456 



1812 5,937,856 
182I 6,801,827 
183I 7,784,539 



The secret of this enormous increase was the habit that the 
Irish peasantry had begun to learn early in the 17th century 
of living upon potatoes. From that dietetic peculiarity, it is 
well known, much of the economic and political history of 
Ireland depends. At the time when it was losing its tribal 
organization (rather late in the day, although not so late as 
in the Highlands of Scotland), the country was in a fair way 
to pass from the pastoral state to the agricultural and industrial. 
It is conceivable that, if Ireland had peacefully become an 
agricultural country, wheaten bread would have become the 
staple food of the people, as in England in early times and 
again in later times ; or that the standard might have been 
oatmeal in the northern province, as in Scotland : in which case 
one may be sure that the population would not have increased 
as it did. " Since the culture of the potatoes was known," says 
a topographer of Kerry in 1756, "which was not before the 
beginning of the last century, the herdsmen find out small dry 
spots to plant a sufficient quantity of those roots in for their 
sustenance, whereby considerable tracts of these mountains are 
grazed and inhabited, which could not be done if the herdsmen 
had only corn to subsist on^" Twenty years later Arthur 
Young found an enormous extension of potato culture, the pigs 
being fed on the surplus crop^ The motive, on the part of 
the landlord or the farmer, was to have the peat bogs on the 
hill-sides reclaimed by the spade ; the surface of peat having 

* Smith's Kerry, p. 88. 

- A Tottr in Ireland... ill 1776-78. l.oiuloii, 171S0. 



MaltJius on poptdation and potatoes. 253 

been removed, a poor subsoil was exposed, which might be 
made something of after it had grown several crops of potatoes, 
but hardly in any other way. Another motive was political ; 
namely, the multiplication by landlords of forty-shilling freeholder 
dependent votes among the Catholics as soon as they became 
free to exercise the franchise \ 

Malthus relied so much upon statistics, that he found the 
case of Ireland, notable though it was, little suited to his method, 
and dismissed it in a few sentences. But he indicated correctly 
the grand cause of over-population : 

" I shall only observe, therefore, that the extended use of potatoes has 
allowed of a very rapid increase of population during the last century (i8th). 
But the cheapness of this nourishing root, and the small piece of ground 
which, under this kind of cultivation, will in average years produce the food 
for a family, joined to the ignorance and depressed state of the people, which 
have prompted them to follow their inclinations with no other prospect than 
an immediate bare subsistence, have encouraged marriage to such a degree 
that the population is pushed much beyond the industry and present resources 
of the country ; and the consequence naturally is, that the lower classes of 
people are in the most impoverished and miserable state." 

In another section he showed that the cheapness of the staple 
food of Ireland tended to keep down the rate of wages : 

"The Irish labourer paid in potatoes has earned perhaps the means of 
subsistence for double the number of persons that could be supported by an 
English labourer paid in wheat... The great quantity of food which land will 
bear when planted with potatoes, and the consequent cheapness of the 
labour supported by them, tends rather to raise than to lower the rents 
of land, and as far as rent goes, to keep up the price of the materials of 
manufacture and all other sorts of raw produce except potatoes. The indo- 
lence and want of skill which usually accompany such a state of things tend 
further to render all wrought commodities comparatively dear... The value of 
the food which the Irish labourer earns above what he and his family con- 
sume will go but a very little way in the purchase of clothing, lodging and 
other conveniences... In Ireland the money price of labour is not much 
more than the half of what it is in England." 

Lastly, in a passage quoted in the sequel, he .showed how 
disastrous a failure of the crop must needs be when the staple 
was potatoes ; the people then had nothing between them and 
starvation but the garbage of the fields ^ 

What the growth of population could come to on these 
terms was carefully shown for the district of Strabane, on the 
borders of Tyrone and Donegal, by Dr Francis Rogan, a writer 

^ The forty-shillings freeholder of Ireland was a life-renter whose farm was worth 
forty shillings annual rent more than the rent reserved in his lease. 

^ Malthus, Essay on the Principle of Population. Bk. II. chap, lo, Bk. III. 
•chap. 8, and Bk. IV. chap. 11. 



254 Fever and Dysentery in Ireland. 

on the famine and epidemic fever of i8i7-i8\ Strabane stood 
at the meeting of the rivers Mourne and Fin to form the Foyle ; 
and in the three valleys the land was fertile. All round was 
an amphitheatre of hills, in the glens of which and among the 
peat bogs on their sides was an immense population. The farms 
were small, from ten to thirty acres, a farm of fifty acres being 
reckoned a large holding. The tendency had been to minute 
subdivisions of the land, the sons dividing a farm among them 
on the death of the father : 

"The Munteiloney mountains," says Rogan, "lie to the south and east 
of the Strabane Dispensary district. They extend nearly twenty miles, and 
contain in the numerous glens by which they are intersected so great a 
population that, except in the most favourable years, the produce of their 
farms is unequal to their support. In seasons of dearth they procure a 
considerable part of their food from the more cultivated districts around 
them ; and this, as well as the payment of their rents, is accomplished by the 
sale of butter, black cattle, and sheep, and by the manufacture of linen cloth 
and yarn, which they carry on to a considerable extent." 

These small farmers dwelt in thatched cottages of three or 
four rooms, in which they brought up large families'"*. Besides 
the farmers, there were the cottiers, who lived in cabins of the 
poorest construction, sometimes built against the sides of a 
peat-cutting in the bog. The following table shows the 
proportion of cottiers to small farmers on certain manors of the 
Marquis of Abercorn, near Strabane, at the date of the famine 
in 1 8 17-18 (Rogan, p. 96) : 



^ Francis Rogan, M.D., Observations on the Condition of the Middle and Lower 
Classes in the North of Ireland, as it tends to promote the diffusion of Contagions 
Fever; with the History and Treatment of the late Epidemic Disorders. London, 
1819. 

■^ William Carleton, the vates sacer of the Irish peasantry, was born, in 1798, in 
one of those Tyrone thatched cottages, in the parish of Clogher. His father had 
changed his holding three times before William, the youngest child, was fourteen years 
old; the last of the four was a farm of sixteen or eighteen acres in the north of 
Clogher parish, and "nearer the mountains." Carleton says that he "lived among 
the people as one of themselves" until he was twenty-two, which would have been 
until the year 1820; so that he probably saw the famine and fever of 1817-18 among 
that very Tyrone peasantry whom Dr Rogan brings before us from the medical side. 
The scenes of famine and fever in the 'Black Prophet' are those "which he himself 
witnessed in 181 7, 1822, and other subsequent years," having been recalled by him in 
the form of a tale which was published in 1846, at the l^eginning of the Great Famine 
of that and the folhnving year. His early recollections of famine and fever come into 
other tales, such as the 'Clarionet,' the 'Poor Scholar' and 'Tubber Derg,' in which 
last is related the almost inevitable reduction to poverty and at length to beggary of 
a most upright and industrious farmer owing to the fall of prices, without fall of rents, 
after the Peace of 1815. Carleton's work has always the quality of fidelity, and 
he may be credited when he says that the scenes of famine and fever are not 
exaggerated. 



Farfners and cottiers in Tyrone. 255 







Number 


of Families 


Manors 




Farmers 


Cottiers 


Derrygoon 




368 


335 


Donelong 




243 


322 


Magevelin ar 


d 






Lismulmug 


hray 


319 


668 


Strabane 




302 


415 


Cloughognal 




328 


279 



The cottiers rented their cabins and potato gardens from the 
farmers, paying their rent, on terms not advantageous to 
themselves, by labour on the farm. For a time about the 
beginning of the century the practice by farmers of taking 
land on speculation to sublet to cottiers was so common that 
a class of " middlemen " arose. One pamphleteer during the 
distress of 1822 speaks of the class of middlemen as an 
advantage to the cottiers, and regrets that they should have been 
personally so disreputable as to have become extinct. It is not 
easy to understand how they served the interests of the cottiers : 
for the latter were answerable to the landlord for the middleman's 
rent, and were themselves over-rented and underpaid for their 
labour. The system of middlemen did not in matter of fact 
answer ; they hoped to make a profit from the tenants under 
them, and neglected to work on their own farms ; it appears 
that they were a drunken class, and that they were at length 
swallowed up in bankruptcy. After the first quarter of the 
century the cottiers and the landlords (with the agents and the 
tithe proctors) stood face to face ; but at the date of the famine 
of 1 8 17 there was subletting going on, of which Rogan gives an 
instructive instance in his district of Ulster\ 

Under this system of subdividing farms and subletting 
potato gardens with cabins to cottiers, the following enormous 
populations had sprung up in four parishes within the 

^ Rogan, u. s. p. 95 : "A fanner within my knowledge, who holds fifteen acres 
of arable land, with nearly an equal quantity of cut-out bog, for which he pays £1% 
per annum, has erected six cabins for labourers. They are built with mud, instead of 
lime, and are thatched, so that they cannot each have cost more than three or four 
pounds. For some time he received from three of his tenants six guineas per annum, 
and from the others two guineas each, the latter only holding a cottage and a small 
garden [the former three having also grazing for a milch cow, half a rood of land for 
flax, and half an acre for oats, with privileges of cutting turf and planting as many 
potatoes as they could each provide manure for] ; but they have been all so reduced 
in circumstances by the late scarcity as to be now unable to keep a cow, and for the 
two last years have rented their cabins and potato gardens alone. All the straw 
raised on the farm would scarcely suffice to keep the houses water-fast if applied 
solely to this purpose." One of the first things that the Marquis of Abercorn did in 
the epidemic of 1817 was to call upon the subletting farmers on his manors to repair 
the roofs of their cottiers' cabins. 



256 Fever and Dysentery in Ireland. 

Dispensary district of Strabane and in four manors of the 
Marquis of Abercorn adjoining them, but not included in the 
Dispensary District : 



Town of Strabane 


3896 


Parish of Camus 


2384 


„ „ Leek 
„ „ Urney 
Manor of Magevelin 


5092 
4886 


and Lismulmughray 
Manor of Donelong 


5548 
3126 


„ „ Derrygoon 

„ „ Part of Strabane 


2568 
2796 



In the language of the end of the 19th century, this would have 
been called a " congested district " of Ireland ; but all Ireland 
was then congested to within a million and a half of the utmost 
limit, so that the famine, which we shall now proceed to follow 
in this part of Ulster, has to be imagined as equally severe in 
Connaught, in Munster, and even in parts of Leinster. 



The Famine and Fevers of 1817-18. 

The winter of 18 15-16 had been unusually prolonged, so 
that the sowing and planting of 1816 were late. They were 
hardly over when a rainy summer began, which led to a ruined 
harvest. The oats never filled, and were given as green fodder 
to the cattle ; in wheat-growing districts, the grain sprouted in 
the sheaf; the potatoes were a poor yield and watery; such 
of them as came to the starch-manufacturers were found to 
contain much less starch than usual. The peat bogs were so 
wet that the usual quantity of turf for fuel was not secured \ 
This failure of the harvest came at a critical time. The Peace 
of Paris in 18 15 had depressed prices and wages and thrown 
commerce into confusion. During the booming period of 
war-prices, from 1803 to 18 15, farms and small holdings had 
doubled or even trebled in rent, and had withal yielded a 
handsome profit to the farmers and steady work to the labourers. 
When the extraordinary war expenditure stopped, this factitious 
prosperity came to a sudden end. The sons of Irish cottiers 
were not wanted for the war, and the daughters were no longer 

1 Carleton, in one of his tales, has given a vivid picture of the hirid or gloomy 
appearance of the country in the late autumn of i8r6, as if it foreboded the distress of 
the following spring. 



Famine in the Spring of i^iy. 257 

profitable as flax-spinners to the small farmers. Weavers could 
hardly earn more than threepence a day, and labourers who 
could find employment at all had to be content with fourpence 
or sixpence, without their food. A stone of small watery 
potatoes cost tenpence ; but the value of cattle fell to one-third, 
and butter brought little. By Christmas the produce of the 
peasants' harvest of 1816 was mostly consumed. "Many 
hundred families holding small farms in the mountains of 
Tyrone," says Rogan, "had been obliged to abandon their 
dwellings in the spring of 18 17 and betake themselves to 
begging, as the only resource left to preserve their lives \" At 
Galway, in January, a mob gathered to stop the sailing of a 
vessel laden with oatmeal. At Ballyshannon the peasants took 
to the shore to gather cockles, mussels, limpets and the remains 
of fish. In some parts the seed potatoes were taken up and 
consumed. The people wandered about in search of nettles, 
wild mustard, cabbage-stalks and the like garbage, to stay their 
stomachs. It was painful, says Carleton, to see a number of 
people collected at one of the larger dairy farms waiting for the 
cattle to be blooded (according to custom), so that they might 
take home some of the blood to eat mixed with a little oatmeal. 
The want of fuel caused the pot to be set aside, windows and 
crevices to be stopped, washing of clothes and persons to cease, 
and the inmates of a cabin to huddle together for warmth. 
This was far from being the normal state of the cottages or 
even of the cabins, but cold and hunger made their inmates 
apathetic. Admitted later to the hospitals for fever, they were 
found bronzed with dirt, their hair full of vermin, their ragged 
clothes so foul and rotten that it was more economical to 
destroy them and replace them than to clean them. 

Some months passed before this state of things produced 
fever. The first effect of the bad food through the winter, such 
as watery potatoes eaten half-cooked for want of fuel, had 
been dysentery, which became common in February, and was 
aggravated by the cold in and out of doors. It was confined 

^ Probably their cattle had been impounded for rent and tithe. The author of 
the pamphlet Lachrymae Hiberniae (Dulslin, 1822), a resident on the western coast, 
says (p. 8), with reference to the seizures for rent and tithe: "Oh what scenes of 
misery were exhibited in Ireland in this way during the years 181 7, '18 and '19 ; by 
that time the people were left without cattle ; after this their potatoes and corn were 
seized and sold, and in some cases their household furniture, even to their blankets." 
The hardness of landlords in general is alleged by Dr Rogan, with an exception in 
favour of the Marquis of Abercorn in his own district. 

c. II. 17 



258 Fever and Dysentery in Ireland. 

to the very poorest, and was not contagious, attacking perhaps 
one or two only in a large family. Comparatively few of those 
who were attacked by it in the country places came to the 
Strabane Dispensary ; but the dropsy which often attended or 
followed it brought in a larger number. The following table 
of cases at the Dispensary shows clearly enough that dysentery 
and dropsy preceded the fever, which became at length the chief 
epidemic malady^: 

Cases at Strabane Dispensary. 

l3l7 Dropsy Dysentery Typhus 

June 23 2 10 

July 107 31 60 

August 40 22 206 

September 9 23 287 

At a few of the larger towns in each of the provinces typhus 
had risen in the autumn of 18 16 somewhat above the ordinary 
low level which characterized the years from 1803 to 18 16 in 
Ireland as well as in Britain. At that time there was steadily 
from year to year a certain amount of typhus in the poorest 
parts of the towns and here or there among the cabins of the 
cottiers. Statistically this may be shown by the table of 
regular admissions to the fever hospitals of some of the chief 
towns from the date of their opening. 

Admissions to Irish Fever Hospitals, 1799-18 18. 





Dublin, 


Dublin 


Cork 


Waterford 


Limerick 


Kilkenny 




Cork St. 


House of 


Fever 


Fever 


Fever 


Fever 


Year 


Hospital 


Industry 


Hospitals 


Hospital 


Hospital 


Hospital 


1799 


— 


— 


— 


146 


— 


— 


1800 


— 





— 


409 


— 


— 


180I 





— 


— 


875 


— 


— 


1802 


— 


— 


— 


419 


446 


_. 


1803 





— 


254 


188 


86 


73 


1804 


4IS 


82 


190 


223 


95 


80 


1805 


1024 


709 


200 


297 


90 


69 


1806 


1264 


1276 


441 


165 


86 


56 


1807 


1 100 


1289 


191 


166 


84 


81 


1808 


107 1 


1473 


232 


^Sl 


100 


96 


1809 


105 I 


I 176 


278 


222 


109 


116 


181O 


1774 


1474 


432 


410 


120 


13s 


181I 


I47I 


I316 


646 


331 


196 


153 


1812 


2265 


2006 


617 


323 


146 


156 


1813 


2627 


1870 


550 


2C2 


227 


183 


1814 


2392 


2398 


845 


175 


221 


236 


1815 


3780 


2451 


717 


403 


394 


249 


1816 


2763 


1669 


1026 


307 


659 


162 


1817 


3682 


2860 


•4866 


390 


2586 


1 100 


I818 


7608 


17894 


10408 


2729 


4829 


1924 



' Tlicrd w.is dyscnlciy also in tlic nutiinm of iSiS. Cheyne, Diibl. Hasp. Rep. \\\. i. 



Fever in ordinary years. 259 

In 1 81 2 the first step was taken towards the adoption of the 
Poor Law, namely the division of the country into Dispensary 
Districts, which remained the units of charitable relief until 
1839, when the old English system of a poor-rate and parochial 
Unions was applied to Ireland. During that intermediate 
period much was left to the medical profession, which contained 
many well-educated and humane men, to the priests and clergy, 
and to charitable persons among the laity. There was fever in 
many places where there were no fever hospitals. A physician 
at Tralee reported that the back lanes of the town, crowded 
with cabins, were seldom free from typhus. Rogan gives two 
instances from the Strabane district in the summer and winter 
of 181 5, at a time when the district was remarkably healthy. 
A beggar boy was given a night's lodging by a cottier at 
Artigarvan, three miles from Strabane. Next morning he was 
too ill to leave ; he lay three weeks in typhus, and gave the 
disease to twenty-seven persons in the eight cabins which 
formed the hamlet. A few months after, about a mile from 
Strabane, a mother fell into typhus and was visited many times 
by her two married daughters and by others of her children 
at service in the neighbourhood. Nineteen cases were traced to 
this focus ; " but the actual number attacked was probably more 
than three times this, as the disease, when once introduced into 
the town, spread so widely among the lower orders as to create 
general alarm, and led to the establishment of the small fever 
ward attached to the Dispensary." It was in April, 18 16, that 
this was done, two rooms, each with four beds, having been 
provided at Strabane for fever cases ; but at no time until the 
summer of 18 17 were they all occupied at once. 

The epidemic really began there in May, 18 17, in a large 
house which had been occupied during the winter by a number 
of families from the mountains ; they had brought no furniture 
with them, nor bedding except their blankets, and lay so close 
together as to cover the floors. Each room was rented at a 
shilling a week, the tenant of a room making up his rent by 
taking in beggars at a penny a night. The floors and stairs 
were covered with the gathered filth of a whole winter; the 
straw bedding, never renewed, was thrown into a corner during 
the day to be spread again at night. Every crevice was stopped 
to keep out the cold ; the rain came in through the roof, the 
floors were damp, and the cellars of the house full of stagnant 

17 — 2 



26o Fever and Dysentery in Ireland. 

water turned putrid. Meanwhile more than a fourth part of the 
families resident in Strabane, to the number of 1026 persons, 
were being fed from a soup-house opened early in the spring 
of 1 8 17, while there were others equally destitute but too proud 
to ask relief. The rumour of this charity soon brought crowds 
of people from the surrounding country, with gaunt cheeks, says 
Carleton, hollow eyes, tottering gait and a look of " painful 
abstraction " from the unsatisfied craving for food. In the 
crowd round the soup-shop, the timid girl, the modest mother, 
the decent farmer scrambled "with as much turbulent solicitation 
and outcry as if they had been trained, since their very infancy, 
to all the forms of impudent cant and imposture." These 
soup-shops were opened in all the Irish towns. At Strabane 
some of the richer class lent money to procure supplies, for sale 
at cost price, of oatmeal, rice and rye-flour, the last being in 
much request in the form of loaves of black bread. 

The fever, having begun among the houseful of vagrants 
above mentioned, made slow progress until June, when it 
spread through the town, and in the autumn became a serious 
epidemic. Meantime the soup-kitchen was closed, the supplies 
having ceased, and the country people returned to their cabins 
carrying the infection of typhus everywhere with them. By the 
middle of October, 18 17, the epidemic was general in the country 
round Strabane. 

The following table shows the rise and decline of the 
epidemic of typhus in the town itself. 

Cases of Fever attended from Strabane Dispensary'^. 





1817 


1818 




1817 


1818 


Jan. 


9 


83 


July 


60 


106 


Feb. 


13 • 


46 


Aug. 


206 


90 


March 


6 


60 


Sept. 


287 


57 


April 


13 


48 


Oct. 


233 


49 


May 


3 


39 


Nov. 


193 


40 


June 


10 


71 


Dec. 


140 


38 



The exact particulars from the Dispensary district of 
Strabane show clearly how famine in Ireland is related to fever. 
The epidemic of typhus was an indirect result of the famine, and 
was due most of all to the vagrancy which a famine was bound to 
produce in Ireland, in the absence of a Poor Law. In the 

^ Kogan, p. 31. 



Causes of the spread of contagion /// 1817-18. 261 

spring of 18 17, said a gentleman near Tralee, "the whole 
country appeared to be in motion." " It was lamentable," 
said Peel, in the Commons debate, on 22 April, 181 8, "at least 
it was affecting, that this contagion should have arisen from 
the open character and feelings of hospitality for which the 
Irish character was so peculiarly remarkable." They gathered 
also at funerals, and, as Graves said of a later epidemic, they 
were " scrupulous in the performance of wakes." The concourse 
of people at the daily distributions of soup was another cause of 
spreading infection, many of them having come out of infected 
houses \ Of such houses, the lodging-houses of the towns, we 
have several particular instances. At Strabane, there were four 
such, which sent ninety-six patients to the fever hospital in 
eighteen months. At Dublin, a house in Cathedral-lane sent 
fifty cases to the fever hospitals in a twelvemonth ; the house 
No. 4, Patrick's close sent thirty cases in eight months; No. ^2\ 
Kevin-street sent from five rooms nineteen persons in six weeks. 
The spread of the disease was much aided by the ordinary 
annual migration of harvest labourers. It was the custom every 
year for cottiers in Connaught to shut up their cabins after the 
potatoes were planted, and to travel to the country round 
Dublin in search of work at the hay and corn harvests, leaving 
their families to beg; in the same way there was an annual 
migration from Clare to Kilkenny, from Cavan, Longford and 
Leitrim into Meath, and from Derry into Antrim, Down and 
Armagh^ In the summer of 18 17 some parishes of Derry were 
left with only four or five families. The keeper of the bridge at 
Toome, over the Bann, counted more than a hundred vagrants 
every day passing into Antrim, from the middle of May to the 

1 The following is an instance, from Boyle, in Roscommon : "In the middle of 
Jmie, 181 7, or a little earlier, a soup-shop was established here by subscription, where 
soup was daily given out to one thousand persons, who, naturally anxious to procure 
it in time, crowded together during its distribution, though every pains was taken to 
keep order amongst them. From the i6th to the 23rd of that month the weather 
became suddenly and unusually hot, and the disease about that period spread rapidly 
among those persons, the greater number of whom attributed the origin of their 
complaint to attendance at the soup-shop ; among that crowd, many of whom I have 
seen faint from absolute want during exposure to the sun, there were persons from 
houses where the disease existed." Report by Dr Verdon of Boyle, 26 June, 181 8, 
in Barker and Cheyne, i. 325. 

^ Dr King of Tralee (Barker and Cheyne, I. p. 177) wrote as follows : "It is a 
custom in this country for very poor persons, living in the country parts, and 
possessing a miserable hovel with a small garden, after they have sowed their 
potatoes, to shut up their hut and carrying their families with them, to roam about 
the country, trusting to the known hospitality of the towns and villages for shelter and 
subsistence till the time for digging the potatoes shall have arrived." 



262 Fever and Dysentery in Ireland. 

beginning of July ; and the same might have been seen at the 
other bridge over the Bann at Portglenone. 

As the spread of contagion came to be reaHzed, the ordinary 
hospitahty to vagrants ceased. Rogan was struck with the 
apathy which at length arose towards sick or dead relatives ; 
even parents became callous at the death of their children (of 
whom many died from smallpox). " For some time," he says, 
" it has been as difficult for a pauper bearing the symptoms of 
ill-health to procure shelter for the night, as it was formerly rare 
to be refused it." In Strabane they extemporised a poor's fund 
by voluntary contributions of £'ip a month, by means of which 
eighty poor families were kept from begging in the streets. In 
Dublin there was so much alarm of infection from the number 
of beggars entering the shops that trade was checked. The 
following, relating to a town in the centre of Ireland, is an 
extreme instance of the panic which the idea of contagion at 
length caused : 

" In TuUamore, when measures were proposed for arresting the progress 
of fever, by the establishment of a fever hospital, so little was the alarm that 
the design was regarded by most of the inhabitants as a well-intentioned 
project, uncalled for by the circumstances of the community. But when the 
death of some persons of note excited a sense of danger, alarm commenced, 
which ended in general dismay : military guards were posted in every 
avenue leading to this place, for the purpose of intercepting sickly itinerants. 
The town, from the shops of which the neighbouring country is supplied 
with articles of all kinds, was thus in a state of blockade. It was apprehended 
that woollen and cotton goods might be the vehicles of infection, and all 
intercourse between the shops and purchasers was suspended. Passengers 
who inadvertently entered the town considered themselves already victims of 
fever. No person would stop at the public inns, nor hire a carriage for 
travelling; in a word all communication between the town and the adjacent 
country was completely interrupted. Apprehension did not proceed in most 
other places to the same extent as in TuUamore 1." 

Several isolated places escaped the epidemic of typhus, 
either for a time or altogether. The island of Rathlin, seven 
miles to the west of Antrim, which was as famished as the 
mainland, had no typhus at the time when it was epidemic 
along the nearest shore ; the island of Cape Clear, at the 
southernmost point of Ireland, had a similar experience. The 
whole county of Wexford, where the soil was dry and the 
harvest of 18 16 had been fair, kept free from typhus until i8i8| 
partly because it was out of the way of vagrants. The towt 
of Dingle, at the head of a bay in Kerry, with old Spanish 

' Barker and Chcyne, 1. 60. 



Extent of tJie fever in Strabane district, 1 8 17-18. 263 

traditions, was totally free from typhus at a time when its near 
neighbour, Tralee, was full of it, the immunity being set down to 
the well-being of the population from their industry at the linen 
manufacture (and fisheries) and their thrifty habits. But the 
counties of Wexford and Waterford, and other places more or 
less exempted in 18 17, had a full share of the epidemic in 1818, 
which was the season of its greatest prevalence in most parts of 
Ireland except Ulster. The harvest of 1817 had been little 
better than that of the year before, although the potato crop 
was hardly a failure. The fine summer of 18 18 brought out 
crowds of vagrants who slept in the open, and, when they took 
the infection, were placed in " fever-huts " erected near theroads^ 
The harvest of that year was abundant, and by the end of 17 18 
the epidemic had declined everywhere except in Waterford. 

The most carefully kept statistics of the sickness and 
mortality were those by Rogan for the Strabane Dispensary 
district, and the adjoining manors of the Marquis of Abercorn, 
for each of which a private dispensary was established under the 
care of a physician. 

Abstract of Returns of the Dispensary district of Strabane, shewing the 
numbers ill of fever from the commencement of the epidemic in the summer 
of 18 1 7, till the end of September, 1818, the numbers labouring under the 
fever at that date, and the mortality caused by the disease (Rogan, p. 72). 





Population 


111 of Fever 


Dead 


Remaining ill 


Town of Strabane 


3896 


639 


59 


13 


Parish of Camus 


2384 


685 


61 


Zl 


„ Leek 


5092 


1462 


96 


57 


„ „ Urney 


4886 


I381 


86 


42 



16,258 4167 302 149 

Similar return for those parts of the Marquis of Abercorn's estates not 
within the Dispensary district : 

Manors 

Magevelin and \ 
Lismulmughray \ 
Donelong 
Derrygoon 
Part of Strabane 

Totals 14,038 5088 337 

^ In Carleton's tale of 'The Poor Scholar,' it is related how the hay-mowers 
stopped in their work to erect a hut for the fever-stricken youth, and a much larger 
hut not far from the first for the numerous persons who ministered to his wants under 
a kind of quarantine arrangement. The stealing of milk from rich men's cows for 
the sick youth is the subject of a dialogue between the Roman Catholic bishop and 
the leader of the kindly party of mowers, in which the latter shows a skill in casuistry 
creditable to his i-eligious instructors. 



Population 


111 of fever 
(to Oct. 1818) 


Dead 


5548 


1666 


lOI 


3126 
2568 
2796 


I217 

I215 

990 


71 
90 

75 



264 Fever and Dysentery in Ireland. 

The proportion of attacks in these tables for a part of 
Tyrone, one-third to one-fourth of the whole population, is 
believed to have been a fair average for the whole of Ireland. 
Each attack, with the weakness that it left behind, lasted about 
six weeks ; cases would occur in a family one after another for 
several months ; in some cottages, says Rogan, only the grand- 
mother escaped. 

One hundred thousand cases were known to have passed 
through the hospitals. Harty thought that seven times as many 
were sick in their cabins or houses, making 800,000 cases in all 
Ireland in two years ; Barker and Cheyne estimated the whole 
number of cases at a million and a half (1,500,000). The 
mortality was comparatively small. It comes out greater in the 
tables for the Strabane district than anywhere else in Ireland 
except the hospital at Mallow. The following table, compiled by 
Harty, shows how widely the fatality ranged (if the figures can 
be trusted), from place to place and from season to season : 

Proportions of fatal cases of typhus in the chief hospitals of Ireland 1817, 
1818 and 1819 (Harty)i. 

1817 1818 1819 Average 





One in 


One in 


One in 


One in 


Dublin 


145 


24 


i8i 


20 


Kilkenny 


1 61 


i4f 


I2| 


i4i 


Dundalk 


20I- 


54 


25' 


30 


Belfast 


19I 


15* 


19 


i7i 


Newry 


21I 


34i 


n\ 


26 


Cork 


29 


35 


35 


33t 
i6| 


Limerick 


13* 


i5i 


3o| 


Waterford 


27+ 


25 


23* 


24f 

19I 


Clonmel 


27 


18 


i8i 


Mallow 


22^ 


9t 




12 


Killarney 


74" 


67 


To 


62 


Tralee 


2o| 


69 


43 


39 



What this meant to particular places will appear from some 
instances. In the parish of Ardstraw, Tyrone, with a population 
of about twenty thousand, 504 coffins are stated by the parish 
minister to have been given to paupers in eighteen months. 
The burials were about twice as many as in ordinary years, 

^ William Harty, M.D., Historic Sketch of the Contagious Fever Epidemic in 
Ireland during 1817-19. Dublin, 1820. This work contains information collected 
by a circular of (jueries addressed to practitioners in the several provinces. It was 
undertaken Ijy Dr Marty at the instance of Sir Jolm Newport, M.P. for Waterford. 
The work by ]3arker and Cheyne on tlie same epidemic took longer to prepare, 
having Ijcen published in 1821. Sec also Cheyne, Diibl. Hosp. Rep. II. i — 147. 



Incidents of the epidemic, i8 17-18. 265 

according to the register of the Cathedral churchyard of 
Armagh : 

181 5 247 burials 

1816 312 „ 



1817 571 

I May — 25 Dec. 
1818 



463 



Of the 463 burials in eight months of 18 18, there were 165 from fever, 
180 from smallpox, and 118 from other causes. 

Barker and Cheyne make the whole mortality of the two 
years from fever and dysentery to have been 65,000; Harty 
makes it 44,300. But not more than a sixth part of the latter 
total were registered deaths, and the estimate of the whole may 
be wide of the mark. In the county of Kerry, ten Catholic 
priests died of it. Many medical men took it, as well as 
apothecaries and nurses, and several physicians died, of whom 
Dr Gillichan, of Dundalk, a young man of good fortune, made a 
notable sacrifice of his life. Everyone bore willing testimony to 
the devotion of the Roman Catholic clergy. Some harrowing 
incidents were reported, such as those from Kanturk, in county 
Cork : 

Dr O'Leary visited a low hut in which lay a father and three children : 
" There were also two grown-up daughters who were obliged to remain for 
several nights in the open air, not having room in the hut till the father 
died, when the stronger of the two girls forced herself into his place. On the 
road leading to Cork, within a mile of this town, I visited a woman of the 
name of Vaughan, labouring under typhus ; on her left lay a child very ill, at 
the foot of the bed another child just able to crawl about, and on her right 
the corpse of a third child, who had died two days previously, and which the 
unhappy mother could not get removed. When the grant arrived from 
Government, I visited a man of the name of Brahill near the chapel gate, 
who with his wife and six children occupied a very small house, all of them 
ill of fever with the exception of one boy, who was so far convalescent as to 
creep to the door to receive charity from the passengers." 

Infants rarely took the fever. Dr Osborne, of Cork, stated that in one 
instance a physician in attendance on the poor had to separate two children 
from the bed of their dead brother, the father and mother being already in a 
fever hospital ; in another instance, he had to remove an infant from the 
corpse of its mother who had just expired in a hoveP. 

Nosologically the epidemic of 18 17-18 presented several 
features of interest. It began with dysentery, and ended with 
the same in autumn, 18 18. It was in great part typhus, but 

^ Barker and Cheyne, p. 65. A similar incident comes into Carleton's tale of 
'The Clarionet': "At length, out of compassion, the few neighbours who feared not to 
attend a feverish death-bed, acting on the popular belief that children under a certain 
age are not liable to catch a fever, placed the boy in her arms." This popular belief 
was well founded. 



266 Fever and Dysentery in Ireland. 

towards the end of the epidemic, in Dublin, at Strabane, and 
doubtless elsewhere, it changed to relapsing fever, that is to say, 
the sick person " got the cool " about the fifth or seventh day 
instead of the tenth or twelfth, but was apt to have one or more 
relapses or recurrences of the fever. The relapsing type was 
milder in its symptoms and was more rarely fatal. The average 
fatality of typhus was much less than in ordinary years, while a 
good many of the fatal cases came from the richer classes, to 
whom the contagion reached, the proportion of fatalities among 
them being noted everywhere as very high, up to one death in 
three or four cases ^ The fatalities were most common, as 
usual, at ages from forty to sixty. A full share of the women 
and children took the fever, perhaps an excess of women, 
allowing for their excess in the population. The following 
were the numbers at each period of life among 18,891 cases 
treated in the hospitals of Dublin and Waterford : 



of age 


I — 10 


ro — 20 


20—30 


30—40 


40—50 


50 and over 


Cases 


2426 


6116 


5230 


2476 


1415 


1228 



The action of the English Government was thought by some 
to have been apathetic. Nothing was done to check the export 
of corn from Irish ports. Peel, who held the office of Irish 
Secretary in 18 17, was probably actuated in this by the same 
constitutional and economic considerations which led him, as 
Prime Minister in 1845, to refuse O'Connell's demand for a 
proclamation against the export of corn. 

Carleton says that there were scattered over the country 
" vast numbers of strong farmers with bursting granaries and 
immense haggards," and that long lines of provision carts on 
their way to the ports met or intermingled with the funerals on 
the roads, the sight of which exasperated the famishing people. 
Several carts were attacked and pillaged, some "strong farmers" 
were visited, and here or there a " miser " or meal-monger was 
obliged to be charitable with a bad grace ; but on the whole 
there was little lawlessness, less indeed than in England in 1756 
and 1766, or in Edinburgh in 1741. In September, 1817, Peel 
commissioned four Dublin physicians to visit the respective 
provinces and report on the causes and extent of the epidemic 

' Accounts from various places in Barker and Cheyne, and in Harty. Rogan 
(u. s. p. 45) says : " The cases of typhus gravior were infinitely more numerous 
among the rich and well-fed than among the poor ; and with them also the head was 
most frequently the seat of diseased action." 



Action of the Government in 1 8 18-19. 267 

fever. On 22 April, 1818, Sir John Newport, member for 
Waterford, for whom Dr Harty had been collecting information, 
raised a debate on the epidemic in the House of Commons, and 
moved for a Select Committee. The debate, after the opening 
speech and a sensible brief reply by Peel, degenerated at once 
into irrelevant talk on the inadequacy of the fever hospital of 
London. The Select Committee was named, and quickly 
reported on the 8th of May. 

A Bill embodying the recommendations of the Committee 
received the royal assent on 30th May. The Act provided for 
the extension of fever hospitals, the exemption of lodging- 
houses, under certain regulations, from the hearth-tax and the 
window-tax, and the formation of Boards of Health with powers 
to abate and remove nuisances. The Boards of Health were 
found unworkable, partly by reason of expense, partly of 
excessive powers. The epidemic having visited Waterford 
somewhat late in its progress, Sir John Newport again called 
attention to it on 6th April, 18 19, and moved for the revival of 
last year's Committee. Mr Charles Grant, afterwards Lord 
Glenelg, who was now Irish Secretary, gave much satisfaction to 
the patriotic members both by his sympathetic speech on the 
occasion and by his previous action at the Irish Office in the 
way of pecuniary help to the fever hospitals or Dispensary 
district officers. The Second Report of the Committee re- 
marked that the rich absentee landlords had given nothing. 
Another Act, of June, 1819 (59 Geo. III. cap 41), defined the 
duties of officers of health, and contained an important clause 
(ix.) relating to the spread of contagion by vagrants. By that 
time the epidemic was over ; nor can it be said that the action 
of the Government from first to last had made much difference 
to its progress. 

Vagrancy was the principal direct cause ; and behind the 
vagrancy were usages and traditions, with interests centuries old, 
which made the landlords resolute not to pay poor-rates on 
their rentals. It was not until twenty years after that the 
English Poor Law was applied to Ireland (in 1839), whereby 
the pauper class were dealt with as far as possible in their 
respective parishes. How far that measure was effective in 
checking the spread of contagion will appear when we come to 
the great famine and epidemic of dysentery and fever in 
1 846-49. 



268 Fever and Dysentery in Ireland. 

It will not be necessary to follow with equal minuteness the 
successive famines and epidemics of typhus, relapsing fever and 
dysentery in Ireland, to the great famine of 1846-49. After 
1 8 17 distress became chronic among the cottiers and small 
farmers. Leases had been entered into at high rents during 
the years of war prices, and in the struggle for holdings tenants 
at will offered the highest rate. When peace came and prices 
fell, rents were found to be excessive, not to say impossible. 
But in Ireland with a rapidly increasing population it was 
easier to put the rents up than to bring them down. Other 
things helped to embarrass the poor cottager : he paid twice 
over for his religion, tithes to the parson, dues to the priest ; 
and he paid all the more of the tithe in that the graziers, who 
were mostly of the established Church and the occupiers of the 
fertile plains, had taken care to make potato land titheable (at 
what date this innovation arose is not stated) but had used 
their power in the Irish Parliament to resist the tithe on arable 
pastures. Again the cottiers or cottagers paid, in effect, the whole 
of the poor rate in the form of alms ; for the dogs of the gentry 
kept all beggars from their gates. 

Famine and Fever in the West of Ireland, 1821-22. 

The next famine in 1821-22 is remarkable for two things 
besides its purely medical interest. Owing to the number of 
desperate evicted tenants, it gave occasion to an increased 
activity of the secret associations, especially the Whiteboys of 
Tipperary and Cork^ ; and it called forth the first great dole of 
English charity in the form of princely subscriptions to a 
Famine Fund. The English charity in 1822 was prompt and- 
large-hearted, contrasting with the tardy help from the exchequer 
in the much more serious famine of 18 17-18. The true ex- 
planation of it is, doubtless, that England on the second occasion 
had more money to spare. The trouble in 1821-22 came from 
the total loss of the potato crop in Mayo, Galway, Clare and 
Kerry, and from a partial loss of it in some other counties of the 
south and west. There was no corn famine, and no general 
dearth. Accordingly it affected the poorest class only, and the 
most remote districts chiefly. The planting season of 1821 had 

' Report on Ihc Present State of the Distressed Distriet in. the South of fret and: 
with an Enquiry into the Causes of the Distresses of the Peasantry and Farmers. 
Dublin, 1822. 



Efforts to meet the famine of 1821-22. 269 

not been favourable, and the yield of potatoes had been poor. 
But the autumn was so wet in the west that the floods in some 
places washed away the soil with the potatoes in it, and in other 
places drowned the potatoes after they had been pitted. The 
flooded state of the basin of the Shannon was a natural calamity 
on the great scale that touched the imagination and loosened 
the purse-strings. A Committee was formed at the London 
Tavern, which sat through the spring of 1822, and quickly raised 
an immense sum. The great mercantile firms of the City and 
of Liverpool gave each a thousand pounds ; a ball at the Opera 
House under the patronage of the king (George IV.) brought 
six thousand, and from all sources the Committee found them- 
selves with three hundred thousand pounds at their disposal 
(forty-four thousand of it from Ireland), while a fund at the 
Dublin Mansion House amounted to thirty thousand more. 
Much of this was sent to Galway, Mayo, Clare and Kerry, in 
time to save many thousands of families from starvation' ; it 
was, no doubt, wastefully given away, and there was a balance 
of sixty thousand pounds sterling unused. More tardily in 
June, 1822, Parliament voted one hundred thousand "for the 
employment of the poor in Ireland," and in July two hundred 
thousand to meet contingencies of the famine. It was generally 
admitted that the Government grants were jobbed and mis- 
appropriated to a scandalous extent. The towns had to be 
made the centres of relief and the depots of provisions ; and yet 
the towns were not suffering from famine or fever but only from 
penury. The fever hospital at Ennis, the county town of Clare, 
was constantly filled by strangers, the townspeople remaining 
healthy. Kerry was one of the most afflicted counties, but 
Tralee and Killarney had no unusual sickness. Limerick town 
had hardly more fever than in an ordinary year. In Dublin the 
admissions for fever in 1822 were a good deal below the usual 
number. On the other hand, Sligo town had much fever, and 
Galway town had an altogether unique experience, the history 
of which, as related by Dr Graves, will be the best possible view 
of the peculiar circumstances of 1821-22^ 

1 Lachrymae Hiberniae, or the Grievances of the Peasantry of Ireland, especially in 
the Westei-n Counties. By a Resident Native. Dublin, 1822 (September). The 
author, a resident of the west coast, was concerned in the distribution of rehef, and 
positively asserts the saving of thousands "from his own personal knowledge." 

^ Robert James Graves, M.D., " Report on the Fever lately prevalent in Galway 
'and the West of Ireland." Trans. K. and Q. Col. Phys. iv. (1824), p. 408. 



270 Fever and Dysentery in Ireland. 

In Connemara, where the distress was acute, there were no 
roads over which the provisions from England could be carted 
to the famished districts. Accordingly a great store was made 
in Galway, to which crowds flocked from the country in boats 
and on foot. Many died a few days after they arrived, from 
exhaustion or from the surfeit of food after long hunger. 
Galway, a crowded place at best, with narrow streets and lanes, 
contained thousands of strangers, who slept about the quays 
and the fish-market, or in the lanes and entries, or in crowded 
lodging-houses four or five in a bed. The fever began in May, 
and quickly spread so much that the priests were kept fully 
employed by calls to the dying. In June and July the sixty 
beds of the fever hospital were filled, principally with the 
fugitives from Connemara. Sixty more beds were added, and 
these by the middle of September were insufficient. The 
infection had now spread to many good houses. When 
Dr Graves and three other Dublin physicians arrived, on 
26 September, they found ropes stretched across the streets to 
stop the wheel traffic. The shops of tradesmen were avoided. 
The town was like a place in the plague ; people passing along 
the streets put their handkerchiefs to their noses when they 
came to a house with fever in it. Yet the number of cases was 
not remarkable ; on 3 October, there were 404 sick in a 
population of 30,000, of whom 130 were in the fever hospital and 
274 at their homes, the new cases occurring at the rate of 29 per 
diem. At length it was found practicable to set up depots of 
provisions in country places, and the crowd of strangers left 
Galway. The fever was mild but tedious among the poor, more 
violent and fatal among the well-to-do. In many country 
places dysentery and choleraic diarrhoea were prevalent, as well 
as fever. In Erris, county Mayo, dysentery and dropsy were 
more common than fever, many of the cottiers having subsisted 
on weeds, shell-fish, or new potatoes dug six weeks after the 
seed was planted. In this famine the people ate the flesh of 
black cattle dead of disease. Excepting in Connemara the 
county of Galway was not so soon affected as some other parts 
of Ireland ; but, as in 1818, the contagion of fever was spread 
abroad by vagrants. After Mayo, Galway, Clare and Kerry, 
the counties most affected were Roscommon and Sligo, and 
next to these Lcitrim, Tippcrary and Cork, 



Outbreak of Dysentery in Dnblin, 1825. 271 

Dysentery and Relapsing Fever, 1826-27. 

Fever and dysentery decreased to an ordinary level in 1823, 
but rose somewhat again in 1824, the summer of which was hot 
and moist. But it was in the hot and dry summers of 1825 and 
1826 that dysentery became notably common in Ireland gene- 
rally and in Dublin in particular. It began in the capital in 
June — among the richer class of people. About the middle of 
August admissions for dysentery were perceptibly raising the 
number of patients in the Cork Street Fever Hospital, and 
continued to do so throughout the autumn. At one dispen- 
sary three out of four applicants had dysentery. All those 
admitted to hospital were over twenty years of age ; of 
thirty-five cases under Dr O'Brien, nine died, all of which had 
ulceration of the great intestine, in one case gangrenous. The 
mortality was not nearly so great among the richer classes, in 
which respect dysentery reversed the rule of typhus fever. 
O'Brien had one obvious case illustrating the curious con- 
nexion between dysentery and rheumatic fever, originally re- 
marked by English observers in the i8th century. A hospital 
porter was admitted with "fever of a mixed catarrhal and 
rheumatic type." Having been blooded and subjected to free 
evacuations, his fever left him on the fourth day, but he was at 
once seized with dysentery, which ran its coursed 

It is to be noted that this epidemic of dysentery began in 
Dublin in the hot June weather of 1825 among the richer 
classes, and that there was no notable increase of fever while 
it lasted. It appears to have declined in DubHn in the 
early part of 1826. After a cold and dry spring there began 
one of the hottest and driest summers on record. The first rain 
for four months fell on the 15th of July, 1826, the thermometer 
rose as high as "^Q", and was on a mean several degrees above 
summer temperature in Dublin. In the spring labour had 
become slack, and before long it was estimated that 20,000 
artizans in the Liberties (weavers and others) were out of work. 
Early in May there began a most extraordinary epidemic of 
relapsing fever, with which some typhus was mixed. By the 
9th of May, the 220 beds of the Cork Street Hospital were full, 

^ John O'Brien, M.D., "On the Epidemic Dysentery which prevailed in Dublin 
in the year 1825." Trans. K. and Q. Col. Phys. V. (1828) p. 221 ; Burke, Ed. Med. 
Surg. Journ. July, 1826, p. 56; Speer, Med. Phys. Journ. N. s. vi. 199. 



272 Fever and Dysentery in Ireland. 

and applicants were sent away daily. On 4 August, a temporary 
hospital of 240 beds was opened in the garden of the Meath 
Hospital; on the 1 8th, the Wellesley Hospital, in North King 
Street, was opened with 113 beds; on the 15th, tents to hold 
180 patients were erected on the lawn of the Cork Street 
Hospital, raising its accommodation to 400; a warehouse in 
Kevin Street was furnished with beds for 230 patients, and 
some increase was made to the beds in Sir Patrick Dun's and 
Stevens's Hospitals. The whole number of fever-beds in Dublin 
hospitals at length reached 1400; but not half the number of 
cases was provided for. At a meeting in the Mansion House 
on 26 October, it was stated that there were at that date 3200 
persons sick of the fever at their homes, besides the 1400 in the 
hospitals. Funds were subscribed, soup-kitchens and dispen- 
saries opened in various districts of Dublin, and kept open most 
of the winter, " but they made little impression on the epidemic, 
which continued with unabated violence." In March, 1827, it 
began suddenly to decline, and fell rapidly until it was nearly 
extinct in May; and that, too, although "the complaints of 
distress and want are to the full as loud as at the commence- 
ment of the epidemic, and provisions are dearer\" The corre- 
sponding sicknesses in Edinburgh and Glasgow were later — the 
fever chiefly in 1828, the dysentery in 1827 and 1828. 

This great epidemic was mainly one of relapsing fever. The 
patient " got the cool," or passed the crisis of the fever, usually 
on the evening of the fifth or seventh day, sometimes on the 
ninth, the evening exacerbation, which was to prove critical, 
being ushered in generally with a rigor, and passing off in 
profuse perspiration throughout the night. The five-day fever 
was more certain to relapse than that of seven days, the 
seven-day fever was more likely to relapse than that of nine 
days. The relapses might be one or two or three or more, 
prolonging the illness for weeks. The clear interval varied from 
twenty-four hours to fourteen days. There were some cases with 
jaundice which led Stokes and Graves to speak loosely of 
"yellow fever^" O'Brien saw only four cases with exquisite 
icterus in fifteen hundred cases of relapsing fever. There was a 
small proportion of cases of ordinary typhus of a severe kind, 

' John O'Brien, "Med. Rep. of llie II. of Recovery, Cork Street, Dublin, for the 
year ending 4 Jan. 1827." Trans, K. and Q. Col. Phys. v. 512. 
■•' Graves, Clinical Medicine, 1843. Lect. xviii. 



The successive types of sickness. 1825-27. 273 

marked by unusual delirium or phrensy and the absence of 
sordes on the teeth or petechiae on the skin ; the typhus cases 
became more numerous in the winter season, or, in other words, 
the original attack lasted to nine, eleven, or thirteen days, with 
little or no tendency to relapse. Gangrene was not uncommon 
in one part of the body or another, and in four cases the feet 
became gangrenous \ 

Even with the admixture of pure typhus cases, and with 
dysenteric complications in the autumn and winter, the mortality 
of the whole epidemic was small — not more than it would have 
been among a third part the number of fever cases in an 
ordinary year. At the Cork Street Hospital alone (including 
the tents) there were 8453 admissions from 4th August, 1826, to 
4th April, 1827, with 332 deaths, or four deaths in a hundred 
cases. The proportion of recoveries was quite as remarkable in 
known instances in the squalid homes of the poor, where two or 
three would be found ill of fever on one pallet, or a father and 
six children in one room, shunned by the neighbours. 

The strangest thing in this epidemic was the sequel of it. 
In the spring of 1827, intermittent fever, which had not made its 
appearance for several years in Dublin, began to prevail pretty 
generally ; whilst the ordinary continued fever showed a strong 
tendency to assume the intermittent and remittent forms. It is 
not surprising, therefore, that Dr O'Brien, who had these varied 
experiences of epidemic dysentery in 1825, of epidemic relapsing 
fever and typhus in 1826, and of intermittent fever in 1827, 
should adopt Sydenham's language of epidemic constitutions, 
and revert to the old Sydenhamian doctrine of causes. While 
the sequence of epidemic diseases in Dublin was some dysentery 
in the autumn and winter of 1825 and relapsing fever on a vast 
scale during the excessively dry spring and summer of 1826, in 
country districts of Ireland, such as Skibbereen, dysentery 
became epidemic after the great drought and heat of 1826, while 
"fever disappeared altogether," and indeed all other prevalent 
forms of sickness gave way before it, so general was it. Such is 
the report from Skibbereen, county Cork, a district that became 
early notorious, in the great famine of 1846-47, and was 
perhaps a kind of barometer of Irish distress twenty years 
earlier. The epidemic dysentery of 1826 attacked all classes 

^ O'Brien, u. s. 

c. II. 18 



2/4 Fever and Dysentery in Ireland. 

there, but chiefly the poorest ; it was apt to begin insidiously, 
and, as it was often neglected, so it often became obstinate and 
hard to cure. Dr McCarthy attributed it to the drought of 
1826, the commercial distress of 1825, the lack of employment 
for labourers, the overgrowth of population, and the alarming rise 
in the prices of food^ He uses the same economic illustrations 
as O'Connell and Smith O'Brien in the Great Famine twenty 
years after, which were, indeed, as old as the time of Bishop 
Berkeley^. 

Although little is heard of the fever of 1826-27 except in 
Dublin, it is probable that the same causes which. produced it 
there were operative in other large towns. The admissions to 
the Limerick Fever Hospital rose rapidly in the end of 1826, 
Geary, who was appointed one of its physicians that year, 
estimates that about one in twelve of the population of Limerick 
(63,310) were treated for fever in 1827 at public institutions, 
besides those treated in private practice. It was relapsing 
fever, as in Dublin ^ 



Perennial Distress and Fever. 

According to all the figures of Irish fever-hospitals, and the 
generalities of their physicians, fever was now constantly present 
in the towns. After the relapsing epidemic of 1826-27 had 
subsided, there was no rise above the steady level until the 
years 183 1 and 1832, when a considerable increase appears in 
the admissions to the hospitals of Dublin, Limerick and Belfast. 
But the fever of 1831-32 was totally eclipsed by the cholera, 
and little is heard of typhus in Irish writings until 1835-36, 
when an epidemic arose, purely of typhus fever, which is said to 
have been as severe upon some districts as that of 1817-18 had 

1 "Remarks on the Epidemic Dysentery of the Autumn of 1826 in the South of 
Ireland." By Alexander McCarthy, M.D. Edin. Med. and Surg. Jot4rn. April, 
1827, p. 289. 

- "It is a melancholy picture of society to witness the increase of wealth and 
luxury on one side, and the greatest want and wretchedness on the other ; to meet 
famine and exhaustion in the great body of the people, in a country that produces as 
much food as would afford a full supply for once and a half its present population ; to 
see the granaries full of corn and flour, and the great body of the people scarcely 
existing on a half supply of bad ]Dotatoes. Such is the miserable situation of the 
Irish, a race of people distinguished for their intellect, and above all for their 
resignation and patience under afflictions the most trying." 

^ Dub. Quart. Joti^-n. Med. Sc. xi. 385. 



ii 



The pauperism of Limerick, 1836. 275 

been. This outbreak fell at the time of the Commission 
presided over by the Earl of Devon, the report of which is 
authoritative for the state of the Irish lower class and the causes 
of the same. The country cottiers and the poor of the towns 
were always on the verge of starvation. Dr Geary, of Limerick, 
in 1836 estimated as follows the proportion of poor to the whole 
population, "the poor" being taken to mean "those who would 
require aid if a Poor Law existed^ : " 

Proportion of ^^ Poor" in the several Pm'ishes of Limerick, 1836. 

St Nicholas St John and 

and St Mary St Laurence St Munchm St Michael 

Population 14,629 15,667 4,071 16,226 

Number of Poor 7,000 6,400 930 2,500 

Most of the poor lived in the old town of Limerick in lofty and 
closely-built houses which the better classes had abandoned. 
These dilapidated barracks were the abodes of misery and filth, 
two and often three families occupying a single room : '•' It is 
here, as in the decayed Liberties of Dublin ^ that the indigent 
room-keeper, the ruined artisan, the unemployed labourer, and 
the ejected country cottier, with their famishing families retreat." 
Their degradation, Dr Geary thought, was owing to the delay 
of Parliament in giving Ireland the Poor Law. The sanitary 
state of the old town was disgraceful. Heaps of manure were 
carefully kept in back yards, to be sold to farmers in the spring 
— "a very principal source of livelihood " for those who collected 
it. Certain houses near these depots had always fever in them, 
dysentery was frequent, and Exchange-lane never free from itl 
An extensive glue-mill in the Abbey poisoned the air with the 
effluvia of putrid animal matters. The following table shows 
the number of fever-cases admitted to the Hospital or attended 
from the Dispensary in 1827 and in four ordinary years 
thereafter : 



^ W. J. Geary, M.D., "Report of the St John's Fever and Lock Hospitals." 
Dub. Quart. Jou7-n. Med. Sc. XI. 378 : XII. 94. 

^ Various descriptions of these exist, of which that by Carleton in the tale ' Barney 
Branagan,' is probably not overdone. 

^ The Report of the Roscrea Fever Hospital for 1827 says : " In March, when 
the dung is being removed from the back yards for the purpose of planting the 
potatoes, the number of patients becomes double in the Fever Hospital." Dublin 
Medical Press, Jan. 1846, p. 235. 

18—2 



2/6 



Fever and Dysentery in Ireland. 



Limerick : — Table of Hospital Cases of Fever attd Cases at their Homes 
attended from the Dispensary. 







Hospital Cases 




Dispensary Cases 








^ 




Average 


/^ 




Average 










mortality. 






mortality. 




Year 


Admitted 


Died 


One in 


Attended 


Died 


One in 


Total 


1827 


2781 


137 


20 


2800 


80 


35 


5581 


1828 


854 


V 


23 


960 


22 


39 


1714 


1829 


506 


23 


22 


640 


18 


35 


1 146 


1830 


806 


34 


23f 
I5I 


910 


25 


36 


1716 


183I 


IOI5 


65 


920 


31 


29 


1935 



Totals 



5962 



296 



6130 176 



34 



From 1 83 1 to 1836 the admissions to hospitals were as follows : 



Year 


Admitted 


Diec 


1832 


1028 


57 


1833 


824 


42 


1834 


906 


55 


1835 


1484 


121 


1836 


3227 


235 



12092 



The last lines show the epidemic increase, which began in the 
autumn of 1835. It will appear from the following (by Geary) 
that it was largely an epidemic of young people, and that the 
fatality was by far the greatest among the comparatively small 
number of persons attacked at the higher ages — a well-known 
law of typhus of which this Limerick demonstration was perhaps 
the first numerically precise : 



Table of the Ntanbers admitted to Limerick Fever Hospital at stated 
ages of five years, with the deaths, from 6 fan. 1836 to 6 fan. 1837. 



Ages in 
Years 


Admitted 


Died 


mortality 
per cent. 


1—5 

5-10 
10—15 


81 
489 
762 


2 

13 
18 


2i 
25 

2± 
5I 

6 


15 — 20 

20 — 25 


701 
362 


37 
22 


25—30 


304 


27 


8| 


30—35 


100 


12 


12 


35—40 


203 


45 


23i 



Ages in 
Years 


Admitted 


Died 


Average 
mortality 
per cent. 


40—45 


70 


13 


18I 


45-50 


82 


22 


27 


50-55 
55—60 
60—65 


23 

36 

2 


5 
12 

I 


2lf 
50 


65—70 


10 


5 


SO 


Over 70 


2 


1 


50 



Total 



3227 235 



7i 



One-sixth of these Limerick hospital cases, to the number of 
567, came from the county, chiefly from the damp, boggy 
districts five to sixteen miles from the city. The whole 
admissions were rather more than the same hospital received in 
the famine year, 18 17. But, although 1836 was not a year of 



Appearance of Spotted Typhus, 1830-40. 277 

special scarcity, there must have been some cause at work to 
raise the perennial typhus to the height of an epidemic, not 
only in Limerick, but in Dublin, Cork, Waterford, Ennis, 
Belfast, and other towns. In the country, an epidemic outburst 
during the months of March, April and May, 1836, in the 
parish of Donoughmore, Donegal, is perhaps only a sample of 
others unrecorded : it was remarkable in that nine-tenths of the 
cases of fever had as a sequel large boils on various parts of the 
body, but principally on the limbs\ 

In Dublin, the influenza of the first months of 1837 seemed 
to check the prevalence of typhus for a time ; but the latter 
increased greatly when the influenza was over, so that the 
admissions to the Cork Street Hospital until the end of 1838 
nearly equalled those of the worst epidemics since the hospital 
was opened in 1804^ Females in typhus were admitted greatly 
in excess of males ; a large proportion (1847 in two years) were 
under fifteen years of age ; the fever rarely relapsed, so that it 
was mostly typhus, as in England and Scotland at the same 
time. In twelve months of the same period (Oct. 1837 to 
Sept. 1838) there were 1786 admissions for fever at Cork, 1840 
at Limerick, and 1706 at Belfast^ 

In Dublin, as in London, Edinburgh and Glasgow, the 
continued fevers of the " thirties " were distinctively spotted 
typhus, which was a new constitution. Graves, lecturing at 
Dublin in November, 1836, said: "We are now at a point of 
time possessing no common interest for the reflection of medical 
observers. It is now nearly two years since my attention was 
first arrested by the appearance of maculated fever, of which the 
first examples were observed in some hospital cases from the 
neighbourhood of Kingstown. This form of fever has lasted 
ever since, prevailing universally, as if it had banished all other 
forms of fever, and being almost the only type noticed in our 
wards\" 



^ Babington, "Epidemic Typhous Fever in Donoughmore." Dub. Quart, yourn. 
X. 404. 

^ G. A. Kennedy, " Report of Cork St. Fever Hosp. 1837-38." Ibid. xiii. 311. 
Graves, Ibid. xiv. 363. 

^ Lynch, Ibid. N. S. Vli. 388, gives some particulars of it also at Lovighrea, Galway, 
in 1840. 

* System of Clinical Medicine. Dublin, 1843, p. 57. The "change of type," 
with special reference to treatment, is discussed more fully in Lecture XXXIV. 
pp. 492-500. See also Dub. Quart. Jourti. Med. Sc. XIV. 502, where a letter on 
the changed character of fever at Sligo is cited. 



278 Fever and Dysentery in Ireland. 

This increase of fever in Ireland, as well as the change in its 
type, corresponded closely to the great epidemic outburst in 
Scotland and England. The census of Ireland, taken in June, 
1 84 1, for the ten years preceding, gave a somewhat loose return 
of the causes of death in each year of the decennial period \ 

The worst years for fever were 1837 and 1840, the best year 
1841. The deaths from fever in ten years were 112,072, being 
I in 1059 of the deaths from all causes. The counties with 
highest fever mortality were Cavan, Mayo, Galway and Clare ; 
the worst towns were Belfast, Kilkenny, Dublin, Limerick and 
Carrickfergus. Of these deaths from typhus-like fevers, 14,501 
occurred in 86 fever-hospitals, which were open, or which kept 
records, for more or less of the decennial period. The following 
table shows the proportions of rural, urban and hospital fever- 
deaths in each of the four provinces : 

Deaths from fever in ten years, 1 831 -41. 

Leinster Munster Ulster Connaught 

Rural fever-deaths 16,159 23,718 21,616 I9)3i9 

Urban 4,626 4,878 3,183 1,262 

Hospital 9,030 5,465 2,439 386 



29,815 34)06i 27,238 20,958 

Rural population j ^^^^^^^^^ ^^^^^^^^^ ^^^g^^^^g ^^^^g^g^^ 

Ratio of do. per) „,„ ^^„ , < ^o^ 

sq.mile \ ^47 332 406 386 

The following detailed table for the province of Leinster shows 
the enormous preponderance of fever-deaths in the cottages or 
cabins^ Only Dublin and Kilkenny have most of the deaths in 
their fever hospitals or public institutions ; it was not until near 
the end of this decennial period, the year 1839, that workhouses, 
with their infirmaries, began to be provided for all the poor-law 
unions : 

^ Tlie Census of Ireland, 1841, Pail. Papers, 1843. "Report on the Table of 
Deaths," by W. R. Wilde. The deaths in the family, with their causes, &c., in each 
of the previous ten years were entered on tlie census paper by the head of the 
family, or by the parish priest for him. These returns were, of course, far from 
exhaustive or correct. 

^ Graves, Clinical Medicine, 1843, p. 46. Remarking on the much greater 
frequency of fever in Ireland than in England, he says (p. 47) : " Notliing can be 
more rcmarkal^le than tlie facility with which a simple cold (which in England would 
be iJcrfectly devoid of danger), runs into maculated fever in Ireland, and that, too, 
under circumstances quite free from even the suspicion of contagion — in trutli, except 
when fever is epidemic, catching cold is its most usual cause." 



Fever in town and country, 1 831-41. 279 

Fever Mortality in Leinster^ 1 831 -41. 



Localities 

Carlow County 
Drogheda Town 
Dublin County 
Dublin City 
Kildare County 
Kilkenny County 
Kilkenny City 
King's County 
Longford County 
Louth County 
Meath County 
Queen's County 
Westmeath County 
Wexford County 
Wicklow County 



;hs from Fever 


Deaths 




Hospitals and 


from Fever 




lie Institutions 


at home 


Total 


202 


891 


1093 


I 


238 


239 


III 


1248 


1359 


6393 


2369 


8762 


276 


1068 


1284 


114 


2378 


2492 


487 


204 


691 


126 


1754 


1880 


3 


1265 


1268 


I 


I20I 


1202 


294 


2151 


2445 


84 


1763 


1847 


54 


1550 


1604 


637 


1736 


2373 


280 


1002 


1282 



9063 20,758 29,821 



The Great Famine and Epidemic Sicknesses of 1846-49. 

The great epidemic of relapsing fever, typhus, dysentery, 
anasarca and purpura, which arose in Ireland in the end of 1846 
or spring of 1847 and lasted until the beginning of 1849, had for 
its direct antecedents the more or less complete loss of the 
potato-crop through blight in two successive autumns, 1845 and 
1846, while the state of distress and sickness was prolonged by 
the potato disease in 1847 and 1848^ The potato-blight, which 
caused so much alarm in Ireland for the first time in September, 
1845, had been seen in Germany several years before, in 
Belgium in 1842, in Canada in 1844, and in England about the 
19th of August, 1845. Shortly after the last date, it attacked 
the Irish potato-fields, first in Wexford, and before the end 
of the year it was estimated that one-third to one-half of the 
yield, which was a fifth larger than usual from the greater 
breadth planted and the abundant crop, was lost by absolute 
rottenness or unfitness for food, the process of decay being of a 
kind to make great progress after the tubers were pitted. The 
loss to Ireland was estimated at about one pound sterling per 
head of the population. Sir Robert Peel was keenly alive 
to the magnitude of the calamity which threatened the Irish 

^ The principal work on the general circumstances of the Irish famine of 1846-47 
is The History of the Great Irish Famine of 1847, with notices of Earlier Irish 
Famines. By Rev. John O'Rourke, P.P., M.R.I. A. Dublin, 1875. 



28o Fever and Dysentery in Ireland. 

peasantry. His first step was to summon to his aid a botanist, 
Dr Lindley, and a chemist, Dr Playfair ; the latter went down 
to Drayton Manor, and joined the prime minister in examining 
samples of the diseased potatoes. The question was whether 
some chemical process could not be found to arrest the decay of 
the tubers. Sir Robert Peel, in a much talked-of address at the 
opening of the Tamworth Reading-Room in the winter of 1840, 
had hailed the rising sun of science and useful knowledge. It 
was only in reference to morals and religion that Peel's 
deliverance called forth criticism, more particularly the memor- 
able series of letters to the Times by John Henry Newman. 
But one of Newman's gibes was in a manner prophetic of Peel's 
attitude in approaching the material distress of Ireland : " Let 
us, in consistency, take chemists for our cooks, and mineralogists 
for our masons." The two professors proceeded to Ireland, but 
could only confirm the fact, already known, that one-third, or 
one-half, of the potato-crop would be lost. 

Botany and chemistry being powerless to stay the effects of 
the potato-blight, the appeal was next to economics. Ireland 
produced not only potatoes but also corn. But for the most 
part the cottiers and cottagers tasted little of the oats or wheat 
which they grew ; as soon as the harvest was gathered, the corn 
was sold to pay the November rents, and was exported. Ireland 
was still in the paradoxical condition which Bishop Berkeley 
puzzled over a hundred years before : " whether our exports do 
not consist of such necessaries as other countries cannot well be 
without.-*" The industry and trade of Irish ports was largely 
that of corn-milling and shipping of oatmeal, flour and other 
produce ; thus Skibbereen in the extreme south-west, where the 
horrors of famine were felt first, had several flour-mills and a 
considerable export trade in corn, meal, flour and provisions. 
The Irish corn harvest of 1845 had been abundant: O'Connell 
cited the Mark Lane Express for the fact that 16,000 quarters of 
oats from Ireland had arrived in the Thames in a single week of 
October ; on the 23rd of the same month the parish priest of 
Kells saw fifty dray-loads of oatmeal on the road to Drogheda 
for shipment. Ireland paid its rent to absentee landlords in 
corn and butter, just as a century before it had paid it largely 
in barrelled beef, keeping little for its own use besides potatoes 
and milk. In the face of the potato famine, the measure 
approved by the Irish leaders of all parties, O'Connell and 



Effects of the famine of 1846 tipon politics. 281 

Smith O'Brien as well as ducal proprietors, was to keep some of 
the oatmeal at home. A committee which sat at the Dublin 
Mansion House were of opinion, on 19 November, 1S45, that 
the quantity of oats already exported of that harvest would 
have sufficed to feed the entire population of Ireland. O'Connell's 
plan was to raise a million and a half on the annual revenue 
of the Irish woods and forests (^74,000), and to impose a tax 
on landlords, both absentee and resident, and with the moneys 
so obtained to buy up what remained of the Irish corn harvest 
for use at home. In the ensuing session of Parliament, both he 
and Smith O'Brien protested that Ireland had no need of 
English doles, having resources of her own if the landlords were 
compelled to do their duty. 

About the same time Lord John Russell, leader of the 
Opposition, was led by the danger of famine in Ireland to 
pronounce for the repeal of the Corn Laws of 1815 ; and at the 
meetings of the Cabinet in December, Peel urged the same 
policy upon his colleagues for the same reason. The political 
history does not concern us beyond the fact that the threatened 
Irish distress caused by the first partial potato-blight of 1845 
was the occasion of the Corn and Customs Act of June, 1846, 
by which the Corn Laws were repealed, and that an Irish 
Coercion Bill, brought in on account of outrages following an 
unusual number of evictions, was made the occasion of turning 
out Peel's ministry at the moment of its Free Trade victory, by 
a combination of Tory protectionists, Whigs and Irish patriots. 

The direct effects of the potato-blight of 1845 were not so 
serious as had been expected. The Government quietly bought 
Indian meal (maize flour) in America without disturbing the 
market, and had it distributed from twenty principal food- 
depots in Ireland, to the amount of 11,503 tons, along with 
528 tons of oatmeal. This governmental action ceased on the 
15th of August, 1846, by which time £733,372 had been spent, 
^368,000 being loans and the rest grants. The people were set 
to road-making, so as to pay by labour for their food, the 
number employed reaching a maximum of 97,000 in August. 
The Government, having been led by physicians in Dublin to 
expect an epidemic of fever, passed a Fever Act in March, 
1846, by which a Board of Health was constituted. But no 
notable increase of sickness took place, and the Board was 
dissolved. There was a small outbreak of dysentery and 



282 Fever and Dysentery in Ireland. 

diarrhoea at Kilkenny (and possibly elsewhere) in the spring of 
1846, which the physician to the workhouse set down to the 
use of the Indian meal "and other substitutes for potatoes^" 

It was the total loss of the potato crop in the summer and 
autumn following, 1846, together vVith a failure of the harvest 
in England and in other countries of Northern Europe, that 
brought the real Irish distress. A large breadth of potatoes 
had been planted as usual, but doubtless with a good deal of the 
seed tainted. An ordinary crop would have been worth, 
according to one estimate, sixteen millions sterling, according to 
another, twice as much. The crop was a total loss. The fields 
looked well in the summer, but those who dug the early 
potatoes found them unusually small. About the beginning of 
August the blight began suddenly and spread swiftly. A letter 
of the celebrated Father Mathew, the temperance reformer, 
brings this out : 

" On the 29th of last month (July) I passed from Cork to Dublin, and 
this doomed plant bloomed in all the luxuriance of an abundant harvest. 
Returning on the 3rd instant (August) I beheld with sorrow one wide waste 
of putrefying vegetation. In many places the wretched people were seated 
on the fences of the decaying gardens wringing their hands and wailing 
bitterly the destruction that had left them foodlessV 

The relief-works and distribution of Indian meal, which had 
been estimated by the Government to last only to August, 1846, 
at a cost of ;^ 476,000 (one-half of it being a free grant), were 
resumed under the pressure of public opinion, in the winter of 
1846 and spring of 1847, at a cost of ;;^4,850,ooo, one-half of the 
sum being again a free grant. Before the distress was over, 
other free grants and advances were made; so that, on 
15 February, 1850, Lord John Russell summed up the famine- 
indebtedness of Ireland to the Consolidated Fund at ^3,350,000, 
(which was to be repaid out of the rates in forty years from that 
date). Allowing an equal sum freely gifted from the national 
exchequer, the whole public cost of the famine would have been 
about seven millions sterling. 

The short crops in Britain in 1846 were an excuse for not 
interfering with the export of oats from Ireland. The imports 
of Indian meal were left to the ordinary course of the market, 
and the distribution to retail traders. The corn merchants of 
Cork, Limerick and other ports made fortunes out of the 

' Joseph Lalor, M.D., Diih. Quart. Joiirn. Med. Sc. N. s. ni. 38. 
2 Cited by O'Rourke, p. 152. 



Relief in the famine and fever, 1846-47. 283 

American cargoes, and the dealers throughout the country made 
large profits. 

To encourage the influx of foreign food-supplies, and to 
lower freights, the Navigation Laws were suspended for a few 
months, so that corn could be carried in other than British 
bottoms. When Parliament met in January, 1847, the distress 
in Ireland occupied the greater part of the Queen's Speech. 

Lord George Bentinck proposed that sixteen millions should 
be advanced for the construction of railroads, so as to give 
employment and wages to the starving multitudes. The 
Government, however, objected that such relief would operate 
at too great a distance, in most cases, from the homes of the 
people ; and it was urged by independent critics that a State 
loan for railways would really be for the relief of the landlords 
more than of the peasantry. The large sums actually voted 
were spent in road-making and in procuring food and medical 
relief A Board of Works directed the relief-works. A Com- 
missariat, with two thousand Relief Committees under it, 
directed the distribution of food. A Board of Health provided 
temporary fever-hospitals and additional physicians. It was 
not to be expected that this machinery would work well, and, in 
fact, the public relief was costly in its administration and often 
misdirected in its objects. Private charities, especially that of 
the Society of Friends, gave invaluable help, money being 
subscribed by all classes at home and sent from distant countries, 
including a thousand pounds from the Sultan of Turkey. On 
one day, the third of July, 1847, nearly three millions in Ireland 
received food gratuitously from the hands of the relieving officers. 
In March, 1847, the public works were employing 734,000. 
The number relieved out of the poor rates at one time reached 
800,000. Workhouses were enlarged, and temporary fever- 
hospitals were built to the number of 207, which in the two 
years 1847 and 1848, received 279,723 patients. 

Emigration to the United States and Canada, which had 
averaged 61,242 persons per annum from the last half of 1841 to 
the end of 1845, rose steadily all through the famine until it 
reached a total of 214,425 in the year 1849, the passage money 
to the amount of millions sterling having come largely from the 
savings of the Irish already settled in the New World. 

The grand effect of the famine upon the population of 
Ireland was revealed by the census of 1851. The people in 1841 



284 Fever and Dysentery in Ireland. 

had numbered 8,175,124; in 185 1 they numbered 6,515,794. 
The decrease was 28'6 per cent, in Connaught, 23-5 per cent, in 
Munster, 16 per cent, in Ulster, and i5"5 per cent, in Leinster. 
In many remote parishes the number of inhabitants, and of 
cabins, fell to nearly a half The depopulation was wholly 
rural, so much, so that there was a positive increase of inhabitants 
not only in the large county towns, but even in small towns 
such as Skull and Kanturk, situated in Poor Law unions where 
the famine and epidemics had made the greatest clearances all 
over\ Our business here is with the epidemical maladies, which 
contributed to this depopulation ; but a few words remain to be 
said on the subject at large. 

Malthus had been prophetic about this crisis in the history of 
Ireland. Criticizing Arthur Young's project to encourage the 
use of potatoes and milk as the staple food of the English 
labourer instead of wheat, so as to escape the troubles of 
scarcity and high prices of corn, Malthus says : 

"When, from the increasing population, and diminishing sources of 
subsistence, the average growth of potatoes was not more than the average 
consumption, a scarcity of potatoes would be, in every respect, as probable 
as a scarcity of wheat at present ; and when it did arrive it would be beyond 

^ The Census of Ireland, 1851. Part V. Table of deaths, vol. I. Dublin, 1856, 

P- 2.35- 

The following are a few instances of depopulation between 1841 and 1851. 

Union of Loughrea, Co. Galway. 

1841 65,636 

1851 38,698 

Union of Clonakilty, Co. Cork. 

1841 52,185 

1851 31,473 

Union of Kantui'k, Co. Cork. 

1841 61,238 

1851 41,801 

Parish of Kanturk. 

1841 4,096 





1851 




6,754 


Union 


of Portumna 


Co. Galway. 




1 841 




30,714 




1851 




19,747 


Union 


of Skibbereen, Co. Cork. 




1841 




57,439 




1 85 1 




37,283 


Parish of Skibb 


sreen. 




184 1 




9,557 




1851 




8,931 


Union 


of Skull, 


Co. 


Cork. 




1841 




26,620 




1851 




16,866 


Parish 


of Skull. 








1841 




2,895 




1851 




3,226 



Check to population and to living on potatoes. 285 

all comparison more dreadful. When the common people of a country live 
principally upon the dearest grain, as they do in England on wheat, they 
have great resources in scarcity; and barley, oats, rice, cheap soups and 
potatoes, all present themselves as less expensive, yet at the same time 
wholesome means of nourishment ; but when their habitual food is the 
lowest in this scale, they appear to be absolutely without resource, except in 
the bark of trees, like the poor Swedes ; and a great portion of them must 
necessarily be starved^." 

The forecast of Malthus was repeated in his own way by 
Cobbett, although neither of them foresaw the potato-blight as 
the means. 

"The dirty weed," said Cobbett in a conversation in 1834, "will be the 
curse of Ireland. The potato will not last twenty years more. It will work 
itself out; and then you will see to what a state Ireland will be reduced... 
You must return to the grain crops ; and then Ireland, instead of being the 
most degraded, will become one of the finest countries in the world. You 
may live to see my words prove true; but I never shalP." 

This is what has come to pass in a measure, and will come 
to pass more and more. Only in some remote parts do the 
Irish cottiers now live upon potatoes and milk. It has come to 
be quite common for them to grow an Irish half acre of wheat, 
and, what is more to the purpose, to consume what they thus 
produce instead of selling it to pay the rent. Doubtless the 
enormous imports of American, Australian and Black Sea wheat 
have made it easier for the Irish to have wheaten bread. But, 
whatever the reason, they have at length adopted the ancient 
English staff of life, a staple or standard which they were in a 
fair way to have achieved long ago, had not their addiction to 
" lost causes and impossible loyalties" given an unfavourable turn 
to the natural progress of the nation^. 

We come at length to the purely medical side of the great 
famine of 1846-47*. The distress in the latter part of the year 

^ Essay on the Principle of Population. Bk. IV. chap. xi. Thorold Rogers has 
in many passages emphasized the advantages of the English practice from medieval 
times of living on the dearest kind of corn ; but he seems to have overlooked the 
priority of Malthus throughout the whole of the eleventh chapter of his fourth book. 
In Six Centuries of Work and Wages (p. 62), Rogers says : " Hence a high standard 
of subsistence is a more important factor in the theory of population than any of those 
checks which Malthus has enumerated." 

^ Cited in Thomas Doubleday's Political Life of Sir Robert Peel. London, 1856, 
II. 398 note. 

^ It is a doctrine of economics that the higher standard of living checks population. 
Thus Marshall says of England : "The growth of population was checked by that 
rise in the standard of comfort which took effect in the general adoption of wheat as 
the staple food of Englishmen during the first half of the iSth century." Economics, 
p. 230. 

^ Vol. VII. (1849) PP- 64-126, 340-404, and Vol. viii. pp. 1-86, 270-339 of the 
Dublin Quart. Journ. of Medical Science, N.S. contain numerous reports collected 



286 Fever and Dysentery in Ireland. 

1846 was felt first in the west and south-west — in the districts to 
which the famine of 1822 had been almost confined. It happened 
that the state of matters around Skibbereen, the extreme 
south-western point of Ireland, was brought most under public 
notice ; but it is believed that there were parts of the western 
sea-board counties of Mayo, Galway, Clare and Kerry from 
which equally terrible scenes might have been reported at an 
equally early period. It was in Clare that relief at the national 
charges was longest needed. 

Dr Popham, one of the visiting physicians to the Cork 
Workhouse, wrote as follows : 

" The pressure from without upon the city began to be felt in October 
[1846], and in November and December the influx of paupers from all parts 
of this vast county was so overwhelming that, to prevent them, from dying in 
the streets, the doors of the workhouse were thrown open, and in one week 
500 persons were admitted, without any provision, either of space or clothing, 
to meet so fearful an emergency. All these were suffering from famine, and 
most of them from malignant dysentery or fever. The fever was in the 
first instance undoubtedly confined to persons badly fed or crowded into 
unwholesome habitations ; and as it originated with the vast migratory 
hordes of labourers and their families congregated upon the public roads, it 
was commonly termed 'the road fever '^" 

It was the same in the smaller towns of the county, such as 
Skibbereen; in the month of December, 1846, there were one 
hundred and forty deaths in the workhouse ; on one day there 
were fifteen funerals waiting their turn for the religious offices. 
Still farther afield, in the country parishes, the state of matters 
was the same. The sea-board parish of Skull was a typical 
poor district, populous with cabins along the numerous bays of 
the Atlantic, but with few residential seats of the gentry. On 
the 2nd of February, 1847, the parish clergyman, the Rev. 
Traill Hall (himself at length a victim to the contagion), wrote 
as follows : 

" Frightful and fearful is the havock around me. Our medical friend, 
Dr Sweetman, a gentleman of unimpeachable veracity, informed me 
yesterday that if he stated the mortality of my parish at an average of thirty- 
five daily, he would be within the truth. The children in particular, he 
remarked, were disappearing with awful rapidity. And to this I may add 
the aged, who, with the young — neglected, perhaps, amidst the wide- 
spread destitution — are almost without exception swollen and ripening for 
the grave^." 

by the editors from all parts of Ireland, and published either in abstract or in full. 
These are the chief medical sources. Some particulars are given also in the Dublin 
Med. Press, 1846 to 1849 in several papers on dysentery. 

1 John Popham, M.D. , Dub. Quart. Journ. Med. Sc. N.s. viii. 279. 

^ Cited by Dr Jones Lamprey, Dub. Quart. Journ. vil. loi. 



I 



Dysentery and Scurvy in 1846-47. 287 

They were "swollen" by the anasarca or general dropsy, 
which was reported from nearly all parts of Ireland as being, 
along with dysentery and diarrhoea, the prevalent kind of 
sickness before the epidemic fever became general in the spring 
of 1847. The same had been remarked as the precursor of the 
fever of 1 817-18. In the end of March, Dr Jones Lamprey, 
sent by the Board of Health, found the parish of Skull " in a 
frightful state of famine, dysentery and fever." Dysentery had 
been by far more prevalent than fever in this district, as in 
many others. " It was easily known," says Dr Lamprey, "if any 
of the inmates in the cabins of the poor were suffering from this 
disease, as the ground in such places was usually found marked 
with clots of blood." The malady was most inveterate and 
often fatal. It must have had a contagious property, for the 
physician himself went through an attack of it'. 

In the Skibbereen district the dead were sometimes buried 
near their cabins ; at the town itself many were carried out in a 
shell and laid without coffins in a large pit^ Along the coast 
of Connemara for thirty miles there was no town, but only small 
villages and hundreds of detached cabins ; this district is said 
to have been almost depopulated^. 

Besides the dysentery and dropsy, which caused most of the 
mortality in the winter of 1846-47, another early effect of the 
famine was scurvy, a disease rarely seen in Ireland and unknown 
to most of the medical men. It was by no means general, but 
undoubtedly true scurvy did occur in some parts : thus in the 
Ballinrobe district, county Mayo^ it was very prevalent in 1846 
for some months before the epidemic fever appeared, being 
"evidenced by the purple hue of the gums, with ulceration 
along their upper thin margin, bleeding on the slightest touch, 
and deep sloughing ulcers of the inside of the fauces, with 
intolerable foetor" — affecting men, women, and children. In 
some places, as at Kilkenny early in 1846, there was much 
purpura^ These earlier effects of the famine (dysentery and 
diarrhoea, dropsy, scurvy and purpura), were seen in varying 
degrees before the end of 1846 in most parts of Ireland. The 
counties least touched by them were in Leinster and Ulster, 

^ Lamprey, Dub. Quart. Joiirn. vii. loi. 

2 O'Rourke. 3 Qmisbey, Dub. Quart. Jom-n. vn. 382. 

^ Pemberton, ibid. vii. 369. 

^ Lalor, u. s. 



288 



Fever and Dysentery in Ireland. 



such as Down, Derry, Tyrone, Fermanagh and some others, 
where the peasantry lived upon oatmeal as well as on potatoes. 
But even these were invaded by the ensuing epidemic of fever, 
the only place in all Ireland which is reported to have escaped 
both the primary and the secondary effects of the famine 
having been Rostrevor, on the coast of Down, a watering-place 
with a rich population, which was also one of the very small 
number of localities that escaped in i8 17-18. 

According to the following samples of admissions to the 
Fever Hospital of Ennis in the several months, the summers 
were the season of greatest sickness, a fact which was noted 
also in the epidemic of 1817-18 : 



Year Month Patients 

1846 November 93 
„ December 224 

1847 June 757 



Year Month 

1848 February- 



May 
November 



Patients 
210 
705 
400 



The almost uniform report of medical men was that the 
epidemic of fever began in 1847, in the spring months in most 
places, in the summer in others. Relapsing fever was the 
common type. It was usually called the famine fever for the 
reason that it was constantly seen to arise in persons " recovering 
from famine," on receiving food from the Relief Committees ^ 
It was a mild or " short" fever, apt to leave weakness, but 
rarely fatal. Dr Dillon, of Castlebar, reports that he would be 
told by the head of a family: " We have been tJiree times down in 
the fever, and have all, thank God, got through it." Dr Starkey, 
of Newry, "knew many families, living in wretched poverty on the 
mountains near the town, who were attacked with fever, and 
who without any medical attendance, and but little attendance 
of any kind, passed through the fever without a single death." 
The doctor of Bryansford and Castlewellan, county Down, 
(where there was no famine), declared that the recoveries of the 
poor in their own cottages destitute of almost every comfort, 
were astonishing. In the Skibbereen district, Dr Lamprey was 
" often struck with the rarity of the ordinary types of fever 
among the thousands suffering from starvation." In some of 
the most famine-stricken places, such as the islands off the coast 

1 Tliis epidemic called forth two pamphlets on the relation of famine to fever, one 
by Dominic Corrigan, M.D., On Famine and Fever as Cause and Effect in Ireland 
("no famine, no fever"), and a reply to it by H. Kennedy, M.D., On the Connexion 
of Famine and Fever, 



Relapsing Fever the common type in 1847, 289 

of Mayo and Galway, and in Gweedore, Donegal, not more than 
one in a hundred cases of relapsing fever proved fatal. In 
Limerick the mortality was " very small." In many places it is 
given at three in the hundred cases, in some places as high as 
six in the hundred. When deaths occurred, they were often 
sudden and unexpected, — more probable in the relapse than in 
the first onset. At Clonmel it was remarked that a certain 
blueness of the nose presaged death ; in Fermanagh it was 
called the Black Fever, from the duskiness of the face. The 
report from Ballinrobe, Mayo, says that it was attended by 
rheumatic pains, which caused the patients to cry out when 
they stirred in bed\ It was mostly a fever of the first half of 
life, and more of the female sex than of the male. One says 
that it was commonest from five to fifteen years of age, another 
from ten to thirty years. 

Relapsing fever was the most common fever of the famine 
years, in the cabins, workhouses and fever hospitals, in the 
country districts as well as the towns and cities. Dr Henry 
Kennedy says of Dublin : " Cases of genuine typhus were 
through the whole epidemic very rare, I mean comparatively 
speaking." But everywhere there was a certain admixture of 
typhus, and in some not unusual circumstances the typhus was 
peculiarly malignant or fatal — many times more fatal than the 
relapsing fever. The poor themselves do not appear to have 
suffered much from the more malignant typhus, unless in the 
gaols and workhouses. When the doors of the Cork workhouse 
were thrown open in December, 1846, five hundred were admitted 
pell mell in one week ; the deaths in that workhouse were 757 in 
the month of March, 1847, and 3329 in the whole year. In the 
Ballinrobe workhouse, county Mayo, " men, women and children 
were huddled together in the same rooms (the probationary 
wards), eating, drinking, cooking, and sleeping in the same 
apartment in their clothes, without even straw to lie on or a 
blanket to cover them." Typhus at length appeared in that 
workhouse, said to have been brought in by a strolling beggar, 
and the physician, the master and the clerk died of it. Wherever 
the better-off classes caught fever, it was not relapsing but 
typhus, and a very fatal typhus. At Skibbereen the relapsing 
fever " was not propagated by contagion ; but in persons so 

^ Pains resembling those of rheumatism were common in the fever of 1817-18 at 
Limerick. Barker and Cheyne, i. 432. 

C. II. 19 



290 Fever and Dysentery in Ireland. 

affected, when brought in contact with the more wealthy and 
better fed individuals, was capable of imparting fevers of 
different types\" There were many opportunities for such 
contact — in serving out food at the depots, in superintending the 
gangs working on the roads, in attending the sessions, in visiting 
the sick. The crowds suffering from starvation, famine-fever or 
dysentery exhaled the most offensive smells, the smell of the 
relapsing fever and the anasarca being peculiar or distinguish- 
able^ There appeared to be a scale of malignity in the fevers 
in an inverted order of the degree of misery. The most 
wretched had the mildest fever, the artizan class or cottagers had 
typhus fatal in the usual proportion, the classes living in comfort 
had typhus of a very fatal kind. This experience, however 
strange it may seem, was reported by medical observers every- 
where with remarkable unanimity. One says that six or seven 
of the rich died in every ten attacks, others say one in three. 
Forty-eight medical men died in 1847 in Munster, most of them 
from fever ; in Cavan county, seven medical men died of fever in 
twelve months, and three more had a narrow escape of death : 
two of the three physicians sent by the Board of Health to the 
coast of Connemara died of fever^. Many Catholic priests died 
as well as some of the Established Church clergy; and there 
were numerous fatalities in the families of the resident gentry, 
and among others who administered the relief Yet a case of 
fever in a good house did not become a focus of contagion ; the 
contagion came from direct contact with the crowds of starving 
poor, their clothes ragged and filthy, their bodies unwashed, and 
many of them suffering from dysentery. The greater fatality of 
fever among the richer classes had been a commonplace in 
Ireland since the epidemic of 1799-1801, and is remarked by the 
best writers*. At Loughrea, in Galway, Dr Lynch observed that 
"in the year 1840 the type of fever was very bad indeed, and 

^ Lamprey, u. s. 

^ Dr Kelly of Mullingar compared the smell of relapsing fever to that of burning 
musty straw. Ditb. Qua7't. Joiirn. Med., Aug. 1863, p. 341. 

^ Cusack and Stokes, ibid. iv. 134. 

^ Barker and Cheyne, Harty, and Rogan have been cited to this effect for earlier 
epidemics. Graves {Clin. Med. pp. 59-60) says : " In the epidemics of 1816, 1817, 1818 
and 1 819, it was found by accurate computation that the rate of mortality was much 
higher among the rich than among the poor. This was a startling fact, and a 
thousand different explanations of it were given at the time." He cites Fletcher 
{Pallioloi;}', \>. 27) an Edinburgh oliserver, as follows : "The rich are less frequently 
affected with epidemic fevers than the })()or, but more frequently die of them. Good 
fare keeps off diseases, jjut increases their mortality when they take place." 



Typhus in 1847-49: Gaol Fever. 291 

very many of the gentry were cut off by it." He reckoned that 
ordinarily one in six cases of fever among the richer class proved 
fatal, one in fifteen among the poor\ But in the great famine, 
six years after, the fever of the poor assumed the still milder type 
of relapsing, fatal perhaps to one in a hundred cases, or three in a 
hundred, while the fever which contact with them gave to those 
at the other extreme of well-being became a peculiarly malignant 
typhus, fatal to six or seven in ten cases, as Dr Pemberton of 
Ballinrobe found, or to three or four in ten cases, as many others 
found. Of course it was the peasantry who made up by far the 
greater part of the mortality in the years of famine ; but they 
were cut off by various maladies, nondescript or definite, while 
the richer classes died, in connexion with the famine, of con- 
tagious typhus and here or there of contagious dysentery. 

Even in the crowded workhouses and gaols, more deaths 
occurred from dysentery than from fever. But in some of the 
gaols great epidemics arose which cut off many of the poor by 
malignant infection. That was an old experience of the gaols, 
studied best in England in the i8th century; the worst fevers, or 
those most rapidly fatal, were caught by the prisoners newly 
brought to mix with others long habituated to their miserable 
condition. The gaols in Ireland during the famine were crowded 
to excess, not so much because the people gave way to lawless- 
ness — their patience and obedience were matters of common 
complimentary remark — but because they committed petty 
thefts, broke windows, or the like, in order to obtain the shelter 
and rations of prisoners. The mortality in the gaols rose and 
fell as follows^ : 



Year 


Deaths in gaol 


Year 


Deaths in gaol 


1846 

1847 
1848 


130 
1320 
1292 


1849 
1850 
185I 


1406 
692 
197 



Most of the deaths in these larger totals came from two or three 
great prison epidemics in each of the series of years — at Tralee, 
Carrick-on-Shannon, Castlebar and Cork in 1847, at Galway in 
1848, at Clonmel, Limerick, Cork and Galway in 1849, the 
highest mortality being 485 deaths in Galway county gaol in 
1848. Descriptions remain of the state of the gaols at Tralee 



Dub. Quart. Journ. Med. Sc. N.S. vil. 
Census of Ireland, 1851. 



19 — 2 



292 Fever and Dysentery in Ireland. 

and Castlebar in 1847, from which it appears that they were 
frightfully overcrowded and filthy. Dr Dillon, of Castlebar, says 
that the county gaol there in March, 1 847, had twice as many 
prisoners as it was built for, " those committed being in a state 
of nudity, filth and starvation." He expected an outbreak of 
typhus, and applied to the magistrates to increase the accommo- 
dation, which they declined to do. In due time, very bad 
maculated typhus broke out, of which the chaplain, matron and 
others of the staff died. This contagious fever is said to have 
proved fatal to forty per cent, of those attacked by it. The 
deaths for the year are returned at 83 in Castlebar gaol, those in 
Tralee gaol at loi, and in the gaol of Carrick-on-Shannon at 100. 
No exact statistical details of the mortality in the great Irish 
famine of 1846-49 were kept. Ireland had then no systematic 
registration of deaths and of the causes of death, such as had 
existed in England since 1837. Information as to the mortality 
was got retrospectively once in ten years by means of the 
census, heads of families being required to fill in all the deaths, 
with causes, ages, years, seasons, &c., of the same, that had 
occurred in their families within the previous decennial period. 
This was, of course, a very untrustworthy method, more 
especially so for the famine years, when many thousands of 
families emigrated, leaving hardly a trace behind, many hamlets 
were wholly abandoned, and many parishes stripped of nearly 
half their inhabited houses. When a certain day in the year 
1 85 1 came round for the census papers to be filled up, a fourth 
part of the people were gone, and that fourth could have told 
more about the famine and the deaths than an equal number of 
those that remained. However, the Census Commissioners did 
their best with the defective, loose or erroneous data at their 
service. Much of the interest of the Irish Census of 1851 
centered, indeed, in the Great Famine ; and the two volumes of 
specially medical information compiled by Sir William Wilde, 
making Part V. of the Census Report, are a store of facts, 
statistical and historical, of which only a few can be given here\ 

1 The Census of Ireland <,/ 1851. Tart V. Table of Deaths. 1 vols. Dublin 
i8<i6 Upwards of two hundred pages are occupied with a chronological /able ot 
Cosmical Phenomena, Epizootics, Epiphitics, Famines and Pestdences ni Ireland 
from the earliest times. This retrospect, which is very replete but tedious and 
uncritical, is followed by a summary report of twenty pages on "The Last Ueneral 
Potato Failure, and the Great Famine and Pestilence of 1845-50, and by a long 
series of tabulated extracts from contemporary writings on all matters relatmg to the 
famine. 



I 
I 



Vital Statistics of the Potato Famine. 293 

Table of Workhouses and Auxiliary Workhouses in Ireland 
diirins: the Famine. 





No. of 


Numbers 


Numbers 


Ratio of deaths 


Year 


Workhouses 


relieved 


that died 


One in 


1846 


129 


250,822 


14,662 


17-11 


1847 


130 


332,140 


66,890 


6-92 


1848 


131 


610,463 


45,482 


13-4 


1849 


131 


932,284 


64,440 


14-47 


1850 


163 


805,702 


46,721 


1774 



During the ten years from 6 June, 1841, to 30 March, 185 1, 
the deaths from the principal infective or " zymotic " diseases in 
the workhouses were as follows : 



Dysentery 


50,019 


Measles 


8,943 


Diarrhoea 


20,507 


Cholera 


6,716 


Fevers 


34,644 


Smallpox 


5,016 



Besides the workhouses, there were during the famine 227 
temporary fever hospitals, which received 450,807 persons from 
the beginning of 1847 to the end of 1850, of whom 47,302 died. 

According to the Census returns, the deaths from the several 
causes connected with the famine were as follows in the respective 
years : 







Dysentery 




Year 


Fever 


(with Diarrhoea) 


Starvation 


1845 


7,249 


— 


— 


1846 


17,145 


5,492 


2,041 


1847 


57,095 


25,757 


6,058 


1848 


45,948 


25,6941 


[ 9,395 


1849 


39,316 


29,4462 


1850 


23,545 


19,224 


— 



According to this table, fever caused more deaths than 
dysentery. But there are reasons for thinking that the deaths 
from dysentery, anasarca and other slow effects of famine and 
bad food really made up more of the extra mortality of the 
famine-years than the sharp fever itself In the returns from 
the workhouses, dysentery is actually credited with about one- 
half more deaths than fever. It is known that most of the 
mortality at the beginning of the famine, the winter of 1846-47, 
was from dysentery and allied chronic forms of sickness. 
Dysentery also followed the decline of the relapsing- fever 
epidemic of 1847-48. Dillon, of Castlebar, says that many, 
who had gone through the fever in the autumn of 1847, fell into 
dysentery in 1848, during which year it was very prevalent. 

1 Of this total, 18,430 deaths were from dysentery and 7,-264 from diarrhoea. 
^ The increase in 1849 was doubtless owing to choleraic diarrhoea during the 
epidemic of Asiatic cholera, the deaths from dysentery being one-half of the total. 



294 Fever and Dysentery in Ireland. 

Mayne says that dysentery often attacked those recovering 
from fever, and proved fatal to them\ In the General Hospital 
of Belfast the fatality of fever-cases was i in 8, " but this 
included dysentery." Probably the same explanation should be 
given of the high rates of fatality in the Fever Hospital of Ennis, 
the chief centre of relief for the greatly distressed county of 
Clare: 1846, i in \2\\ 1847, i in 5f ; 1848, i in ^\. 

It will be noticed that some thousands of deaths were put 
down to starvation in the Census returns. Perhaps a more 
technical nosological term might have been found for a good 
many of these, such as anasarca or general dropsy. But even 
if physicians had made the returns, instead of the priests or 
relatives, they would have put many into a nondescript class, 
for which starvation was a sufficiently correct generic name. 
Scurvy was another disease of malnutrition which was far from 
rare during the famine ; the deaths actually set down to that 
cause were some hundreds over the whole period. 

The deaths from all causes in the decennial period covered 
by the Census of 185 1 were 985,366. But these returns were 
made, as we have seen, on a population which had been reduced 
by a fourth part in the course of ten years, so that they fall 
considerably short of the reality. If the population of Ireland 
had multiplied at the same rate as that of England and Wales 
from 1841 to 185 1, namely, 1*0036 per cent, per annum, it should 
have been 9,018,799 in the year 185 1 ; but it was only 6,552,385. 
Emigration beyond the United Kingdom had averaged 61,242 
persons per annum from the 30th of June, 1841, to the 31st 
December, 1845 ; next year, 1846, it rose to 105,955, in 1847 it 
was "more than doubled," in 1848 it was 178,159, in 1849, 
214,425, in 1850 it was 209,054, and in 185 1 it touched the 
maximum, 249,721. Nearly a million emigrated in the six years 
preceding the' date of the Census, and there was besides a 
considerable migration to Liverpool, Glasgow, London and 
other towns of England and Scotland. It is probable that 
emigration accounts for two-thirds of the decrease of inhabitants 
revealed by the Census of 185 1 ; but the extra mortality of the 
famine years, or the deaths over and above the ordinary deaths 
in Ireland during a decennial period, can hardly be estimated 
below half a million. 

^ R. Mayne, M.D., "Observations on the late Epidemic Dysentery in Dublin." 
Diib. Quart. Journ. Med. Sc. vii. 294. See also papers in Dubl. Med. Press, 1849. 



Public Health since the Potato Famine. 295 



Decrease of Typhus and Dysentery after 1849. 

The potato famines of 1845-48 were a turning-point in the 
history of Ireland. From that time the population has steadily 
declined and the well-being of the people steadily improved. 
By the Census of 1871 the population was 5,386,708, by that of 
1 88 1 it was 5,144,983, by that of 1891 it was 4,704,750. Regis- 
tration of births and deaths, which began in 1864, shows the 
following samples : 

Year Births Deaths 

1867 144,318 98,911 

187I 151,665 88,720 

1880 128,010 102,955 

1888 109,557 85,892 

The enormous amount of pauperism which followed the 
great famine was at length brought within limits: from 1866 to 
the present time it has been marked by a steady increase of 
out-door relief, and by some increase in the numbers within the 
Union Workhouses ; the out-door paupers have increased from 
10,163 on I Jan., 1866, to 53,638 on i Jan., 1881, the absolute 
number of indoor paupers having remained, on an average of 
good and bad years, somewhat steady in a declining population. 

The public health has been undisturbed by great epidemics 
since the potato famine, although the effects of that calamity did 
not wholly cease until some years after. It is best estimated by 
the mean annual average of deaths among a thousand inhabit- 
ants, a ratio which has been low for the provinces of Connaught 
and Munster, and not excessive for the provinces of Ulster and 
Leinster. The following tables are of the death rates in two 
sample years, 1880 and 1889 respectively ^ : 

1880 i88g 

Connaught I5"3 12-4 

Munster i9'5 I5'i 

Ulster 20-0 i6'8 

Leinster iy2> i8'3 



Four healthiest counties . 



1880 

Mayo 14-5 

Sligo 15-3 

Galway 1 5 "6 

Roscommon 1 5 -8 



1889 

Gahvay 1 1 '8 

Kerry I2"i 

Leitrim I2*i 

Cavan I2'2 

^ 17th and 26th Reports of the Regr.-Genl. Ireland. 



296 Fever and Dysentery in Ireland. 



Four unhealthiest counties . 



1880 

Dublin CO. 317 

Waterford co. 24"9 

Louth 2 2 '6 

Antrim 2 1 "9 



1889 

Dublin CO. 24-5 

Antrim 21 "2 

Down i8'6 

Armagh i7"o 



The higher death rates of some counties are chiefly owing to 
their greater urban populations. The health of the cottier 
districts is remarkably good, and is rarely if ever disturbed by 
any morbits iniseriae. The cabins, except in a few remote parts, 
are more comfortable than they used to be, the diet is better, 
the clothing is better, the education of the children is better. 
The present happier lot of the Irish peasantry can be measured 
not unfairly by the statistics showing the decrease in the number 
of cabins of the lowest class, and the increase of dwellings in the 
higher classes. 

The history of fever and dysentery in Ireland subsequently 
to the great epidemics of 1846-49 has few salient points. 
Dysentery, the old " country disease," has steadily declined to 
about a hundred deaths in the year, while the considerable 
mortality from diarrhoea, nearly two thousand deaths in a year, 
is nearly all from the cholera infantum or summer diarrhoea of 
children in the large towns. The history of the continued fevers 
is made complex by the modern identification of typhoid or 
enteric fever. According to the testimonies of several, it played 
but a small part in the epidemics of 1846-49, even in Dublin 
itself S and it can hardly be doubted that its recent increase in 
that city is not apparent but real. The following table from the 
year 1880 to the present time will show how the deaths from 
continued fever are now divided in the registration returns : 

Simple 
Year Typhus continued Enteric 

1880 934 1073 1087 

1881 859 774 813 

1882 744 657 844 

1883 810 593 853 

1884 628 572 693 

1885 505 443 716 

1886 394 380 772 

1887 405 385 740 

1888 362 330 741 

1889 359 250 968 

1890 391 231 855 

1891 266 183 859 

1892 268 210 714 

^ Review of Murchison in Dub. QiiarL Jouni. Med. Sc, Aug. and Nov. 1863, 



The epidemic fevers of 1864-65. 297 

This decline of typhus in a country where for many genera- 
tions it seemed to be a national malady is a remarkable testimony 
to the influence of the changed conditions which have made 
typhus rare everywhere. 

There are some interesting points in connexion with Irish 
typhus since 1849. After the subsidence of the great epidemic 
of relapsing and typhus fevers (1847-49), says Dr Dennis 
O'Connor, of Cork, " intermittent fever made its appearance, 
and, as long as it lasted, scarcely a case of continued fever was 
seen. As soon as the last cases of intermittent disappeared, 
the present epidemic broke out (1864-65), and still rages with 
much severity. This alternation of continued and intermittent 
fever is remarkable. Indeed it might have been observed that 
the fever of 1847 passed first into a remittent form, and gradually 
into the intermittent which prevailed more or less for ten years 
subsequently\" The same succession of relapsing fever by 
intermittent fever was observed after the epidemic of 1826 by 
Dr John O'Brien, of Dublinl The epidemic of fever which 
Dr O'Connor describes for Cork in 1864-65, appeared in Dublin 
about the same time — the latter half of 1 864. It was of the nature 
of typhus in both cities, cerebro-spinal in part, but probably not 
typhoids At Cork it had some peculiarities — a croupous-Iike 
exudation on the tongue, resembling thrush in the mouth, and 
a dark mottled rash (rubeola nigra), or fiery red spots on a dark 
red ill-defined base. " The true typhoid rash has been seen but 
seldom, and the petechiae of genuine typhus, so frequent in 
former epidemics, have been equally rare. The latter I attribute 
to the improved condition of our poor in good clothing and the 
ventilation of their dwellings." The intellect was little disturbed 
in this fever, there was usually a crisis about the fourteenth day, 
and there were no relapses. The sequelae were peculiar — "great 
nervous debility, leading to a semi-paralysed state of the limbs," 
congestion of the lungs, sometimes solidification, or gangrene 
or suppuration of them. It occurred at a time " when the food 
of the people is most abundant and of the best quality." There 

pp. 169 and 339: "We are able, from extensive opportunities of observing the 
epidemic [of 1846-48] in Dublin, to verify the statement of Dr H. Kennedy as to the 
infrequency of enteric fever." 

1 Dub. Quart. Jozirn. Med. Sc. Nov. 1865, p. 285. 

^ See p. 273, supra. 

^ O'Connor, u. s. p. 286, "Typhoid has scarcely appeared in this locality, which 
cannot boast of the excellence of its sewerage." 



298 Fever and Dysentery in Ireland. 

had been three bad harvests in succession from i860, but it may 
be inferred from a Dublin article of August, 1863, that no 
epidemic of typhus had arisen in Ireland down to that date, 
although there was much typhus in England, especially in 
Lancashire owing to the " cotton famine." When the epidemic 
did arise in Dublin, Cork, and doubtless elsewhere in Ireland, 
in the latter part of 1864, to continue throughout 1865, it was 
not connected with scarcity or distress among the common 
people. On the other hand, Dr Grimshaw, of Dublin, found 
that it was subject to influences of the weather, as if the infec- 
tive principle had been a soil poison like that of plague, yellow 
fever, cholera, or enteric fever. Taking the Cork Street Fever 
Hospital for his study, he made out that there was a very close 
correspondence, from the 29th of May to the 31st of December, 
1864, between the fluctuating pressure upon its accommodation 
and the periodic rises in the atmospheric moisture and heat, 
the crowd of patients being always greater when a high tempe- 
rature coincided with a large rainfalls One would not have 
been surprised to find some such law as that in enteric or 
typhoid fever, although a correspondence from day to day is 
subject to many sources of fallacy ; but, by all accounts, the 
disease was typhus, the last of the considerable outbreaks of it 
in Ireland hitherto, and an outbreak that seemed to require, 
both at Cork and Dublin, the language of Sydenham's epidemic 
constitutions for its adequate description. For a good many 
years, the continued fever of Dublin has been chiefly enteric or 
typhoid. As late as 1862 a physician to the Fever Hospital, 
unconvinced by the method of Sir William Jenner, believed that 
he observed a transition from the old typhus into the new 
enteric : " The change at first seemed to be to the gastric type ; 
to which was shortly added diarrhoea in nearly every instance ; 
and this latter, again, occurring in a large number of cases which 
presented all the characters of typhus, including a dense crop of 
petechiael" Assuming that there had been a mixture of cases 
of enteric and typhus fevers, the latter must have had diarrhoea 
among the symptoms, as they often had in special circumstances 
(as well as tympanitis). Since that time the species of typhus 

1 "On Atmospheric Conditions influencing the Prevalence of Typhus Fever." 
Dub. Quart. Joiirii. Alcd. Sc, May, 1866, p. 309. 

'^ li. Kennedy, M.D., "Further Observations on Typhus and Typhoid Fevers as 
seen in IJuljlin." Jdi(/., Aug. 1862, p. 50. 



Increase of Enteric Fever in Dnblin and Belfast. 299 

has greatly declined, and the species of typhoid has considerably 
increased. The remodelling which Dublin has undergone, like 
all other old cities, explains the one fact. The notorious 
Liberties have been in great part rebuilt, and the conditions of 
typhus, as well as its actual fomites, to that extent removed. 
On the other hand, something has happened to encourage the 
soil poison of enteric fever. It is not easy to say what are 
the conditions that have favoured the enteric poison in modern 
towns ; but there can be little doubt about the fact in general, or 
that Dublin and Belfast are among the best fields for the study 
of the problem \ 

^ Nearly one-half of all the enteric fever deaths in Ulster and Leinster come 
respectively from Belfast and Dublin : 

Year Belfast Dublin 

1889 236 231 

1890 190 168 

1891 156 185 



CHAPTER III. 

INFLUENZAS AND EPIDEMIC AGUES. 

Epidemic agues are joined in the same chapter with influ- 
enzas for the reason that they can hardly be separated in the 
earlier part of the history. Until 1743 the name influenza was 
not used at all in this country. The thing itself can be identi- 
fied clearly enough in certain instances from the earliest times. 
But there are periods, such as 1657-59, 1678-79, and 1727-29 
when short waves of epidemic catarrhs or catarrhal fevers came 
in the midst of longer waves of epidemic agues, " hot agues," or 
intermittents, the whole being called by the people "the new 
disease," or " the new ague," while by physicians, such as Willis 
and Sydenham, they were taken to be the distinguishable consti- 
tuent parts of one and the same epidemic constitution. The 
last period in which epidemic agues were so recognised and 
named in England was from 1780 to 1785 ; and in the midst of 
that also there occurred an epidemic catarrh — the " influenza " 
of the year 1782. It is possible that our own recent experience 
of a succession of influenzas, or strange fevers, from 1889 to 
1893, in some respects the most remarkable in the whole history, 
would have seemed an equally composite group if they had 
fallen in the 17th century and had been described in the termino- 
logy of the time and according to the then doctrines or nosolo- 
gical methods. Without prejudice to the distinctness and unity 
of the influenza-type in all periods of the history, I am unable, 
after trying the matter in various ways, to do otherwise than 
take the epidemics of ague in chronological order along with 
the influenzas. As the history will require the frequent use of 
the name "ague," and, in due course, that of the name "influ- 
enza," it will be useful to examine at the outset their respective 
etymologies and the meanings that usage has given to them. 






Original meaning of " Agne." 301 

Originally the English name ague did not mean a paroxysmal 
or intermittent fever, or a fever with a long cold fit followed by 
a hot fit, or the malarial cachexia with sallowness, dropsy and 
enlarged spleen, or any other state of health arising from the 
endemic conditions which are known as malarial over so large a 
part of the globe in the tropical and sub-tropical zones. It 
meant simply aatta, the adjective oi febris acuta made into a 
substantive. Thus Higden's reference in the Polychronicon 
(which is exactly in the words of Giraldus Cambrensis a century 
and a half before) to the febris acuta of Ireland is translated by 
Trevisa (14th cent,): "Men of that lond haue no feuere, but 
onliche the feuere agu, and that wel silde whanne " ; and by an 
anonymous translator : " The dwellers of hit be not vexede with 
the axes excepte the scharpe axes, and that is but selde\" 
Again in the MS. English translation of the Latin essay on 
plague by the bishop of Aarhus, the acute fever which is 
described as the attendant or variant of bubo-plague proper 
(well known long after as the pestilential fever, a malignant 
form of typhus), is thus rendered : 

" As we see a sege or prevy next to a chambre, or of any other particular 
thyng which corrupteth the ayer in his substance and quaUtee : whiche is a 
thing maye happe every daye. And therof cometh the ague of pestilence. 
And aboute the same many physicions be deceyved, not supposing this axes 
to be a pestilence... And suche infirmite sometime is an axes, sometime a 
postume or a swellyng — and that ys in many thinges." 

The same use of ague is continued in the first native English 
book on fevers, Dr John Jones's ' Dyall of Agues,' which has 
chapters on plague as well as on pestilential fever and on all 
other fevers including intermittents. In Ireland the name of 
ague was applied until a comparatively late period to the 
indigenous typhus of the country, as if in literal translation of 
the febris acuta first spoken of by Giraldus in the 12th century. 
Ague in early English meant any sharp fever, and most com- 
monly a continued fever. The special limitation to intermittents 
appears to have followed the revival of the study of the Graeco- 
Roman writers on medicine, Galen above all, in the sixteenth 
century. But Jones, who was freer than the more academical 
physicians of his time from classical influences, is shrewd enough 
to see that it was a mistake to transfer the experiences of 
Greece verbatim to England and to make them our standard of 

^ Higden's Polychronicon. Rolls Series, I. 332. 



302 Influenzas and Epidemic Agues. 

authority : he is speaking, however, not of intermittents but of 
the simple ephemeral fever, or inflammatory fever of one day: 

"Such as have the fever of heat or burning of the sun, sayeth Galen, 
theyr skin is drye and hot as that which is perched with the sun ; of the 
which, in this orizon and countrye of oures, we have no great nede to 
entreate of, leaving it to the phisitions and inhabitantes that dwell nerer to 
the meridional! line and hoter regions, as Hispaine and Africke^" 

At a later date, when the Hippocratic tradition had displaced 
the Galenic, Rogers of Cork, perhaps the earliest writer on fevers 
whose observations are essentially modern, has occasion thus to 
reflect upon the extreme deference of Sydenham to his Greek 
model : " Again we learn from Hippocrates that fevers in the 
warmer climates of Greece, at Naxos, Thasos or Paros, ran. 
their course in certain periods of time, which no ways answers 
in regions removed at a farther distance from the sun," — Rogers 
himself having had no experience of intermittents among all the 
fevers and dysenteries that he saw from 1708 to 1734, although 
Cork was surrounded by marshes^ 

At the time of the Latin translations of Greek medical 
writings by Linacre and Caius in the Tudor period, there were 
in this country actual experiences of strange fevers, which were 
interpreted according to the Greek teaching of quotidians, ter- 
tians and quartans, with their several bastard or hybrid or 
larval forms. These, as I have said, were certainly not the 
endemic fevers of malarious districts; they were, on the contrary, 
widely prevalent all over the country during one or more seasons 
in succession and more occasional for a few years longer ; then 
there would be a clear interval of years, and again an universal 
epidemic of " the new fever," " the new acquaintance," " the new 
ague " or the like. 

Sydenham, for example, has much to say of agues or inter- 
mittents prevalent in town and country for a series of years, and| 
then disappearing for as long a period as thirteen years at 
stretch. But he does not count these as the agues of th« 
marsh; his single reference to the latter is in his essay on"* 
Hysteria, where he interpolates a remark that, if one spends 
two or three days in a locality of marshes and lakes, the blood 
is in the first instance impressed with a certain spirituous 



1 Dyall of Agues. London, [1564]. 

^ Essay on Epidemic Diseases. Dublin, 1734. 



Epidemic Agues distinguished from endemic. 303 

miasma, which produces quartan ague, and that in turn is apt to 
be followed, especially in the more aged, by a permanent 
cachectic stated If Sydenham had intended to bring all the 
intermittents of his experience into that class, he would not 
have left the paludal origin of them to a casual interpolated 
remark. On the other hand, he refers the epidemic agues, 
which occupy his pen so much, to emanations from the bowels 
of the earth, according to a theory of his friend Robert Boyle, 
applied by the latter to epidemical infections in general and to 
epidemic colds or influenzas in particular. Sydenham and his 
learned colleagues were not ignorant of the endemic agues of 
marshy localities, but they made little account of them in 
comparison with the aguish or intermittent fevers that came in 
epidemics all over England. 

In admitting the reality of such agues, we must be careful 
not to ascribe them to such conditions as Talbor, the ague-curer, 
found in one village in Essex. We must be careful not to do so, 
because there are plausible reasons for doing so. The ground 
is much better drained now than formerly; there is less standing 
water, fewer marshes, a much smaller extent of water-logged 
soil. But the malarious parts of England have been tolerably 
well defined at all times ; and at all times the greater part of 
the country was as little malarious as it is now. It is the 
frequent reference to agues in old medical writings that has led 
some modern authors to construct a picture of a marshy or 
water-logged England, for which there is no warrant. Cromwell 
died of a tertian ague which he caught at Hampton Court; 
therefore " the country round London in Cromwell's time " must 
needs have been " as marshy as the fens of Lincolnshire are 
now." The country round London was much the same then as 
now, or as in John Stow's time, or as in the medieval monk 
Fitzstephen's time, or as it has ever been since the last geolo- 
gical change. The ague of which Cromwell died in the autumn 
of 1658 was one of those which raged all over England from 
1657 to 1659 — so extensively that Morton, who was himself ill 
of the same for three months, says the country was "one vast 
hospital." Whatever was the cause of that great epidemic of 
"agues," and of others like it, we have no warrant to assume 
that " the country round London," or wherever else the epidemic 

' Dissert. Efistol. § 93, Greenhill's ed. p. 378, 



304 Influenzas and Epidemic Agues. 

malady prevailed, was then as marshy as the fens of Lincoln- 
shire\ 

The other name in the title of this chapter, influenza, 
appeared comparatively late in the history. It is an Italian 
name, which is usually taken to mean the influence of the stars. 
It may have got that sense by popular usage, but the original 
etymology was probably different. As early as the year 1554 
the Venetian ambassador in London called the sweating sick- 
ness of 1 55 1 an influsso, which is the Italian form of infliixio. 
The latter is the correct classical term for a humour, catarrh, or 
defluxion, the Latin defltwio itself having a more special limited 
meaning. It was not astrology, but humoral pathology, that 
brought in the words influxio and influsso ; and I suspect that 
influenza grew out of the latter, but not out of the notion of an 
influence rained down by the heavenly bodies. 

It was in 1743 that the Italian name of "influenza" first 
came to England ^ the rumour of a great epidemic, so called, at 
Rome and elsewhere in Italy having reached London a month 
or two before the disease itself The epidemic of 1743 was soon 
over and the Italian name forgotten ; so that when the same 
malady became common in 1762, some one with a good 
memory or a turn for history remarked that it resembled "the 
disease called influenza" nearly twenty years before. After the 
epidemic of 1782, the Italian name came into more general use, 
and from the beginning of the present century it became at once 
popular and vague. The great epidemics of it in 1833 and 1847 
fixed its associations so closely with catarrh that an "influenza 
cold " became an admitted synonym for coryza or any common 
cold attended with sharp fever. Lastly, the series of epidemics 

^ One regrets to find the above mistake in the learned pages of Murchison (p. 8). 
The following by Dr Robert Williams {Morbid Poisons, 11. 423) is absolutely 
erroneous: "In Sydenham's time, intermittent fever and dysentery were constantly 
endemic in London ; and the mortality from the former cause alone averaged, in a 
comparatively small population, from one to two thousand persons annually." What 
Sydenham says is that dysentery was endemic in Ireland (on the authority of Boate, 
no doubt), that it was epidemic in London in the end of 1669 and in the three years 
following, and that for the space of ten years it had appeared quite sparingly (qtiae per 
decennitttn jam parcitis coniparucrat). As to intermittents, he says they were absent 
from London for thirteen years, from 1664 to 1677, except in sporadic or imported 
cases. In the London bills the deaths from "agues" are sometimes distinguished 
from "fevers," and are then seen to be only some dozen or twenty in two 
thousand. 

^ It is used in the I^atin title of an Edinljurgji graduation thesis, " De Catarrho 
epidemio, vel Influenza, prout in India occidentali sese ostendit," by J. Iluggar, which 
is assigned in I laser's bibliography to the year 1703. Having been unable to find the 
thesis, I have not verified the date. 



Early names of Influenza. 305 

from 1889 to 1893 effectually broke the association with coryza 
or catarrh. 

Before influenza became adopted as the common English 
name towards the end of last century, what were the names 
popularly given to the malady in this country ? The earliest 
references to it are in the medieval Latin chronicles under the 
name of tnssis or cough, or in some periphrasis. In the fifteenth 
century the English name was " mure " or " murre," which 
appears to be the same root as in murrain. Thus the St Albans 
Chronicle, under the year 1427, enters a certain "infirmitas 
rheumigata," which in English was called "mure"; and the 
obituary of the monks of Canterbury abbey has two deaths 
from '• empemata, id est, tussis et le murra\" In the Tudor 
period there is no single distinctive name, unless it be " hot 
ague": in 1558 the name is "the new burning ague," in 1562 
"the new acquaintance," in 1580 "the gentle correction," and at 
various times in the 17th century "the new disease," "the new 
ague," " the strange fever," " the new delight," " the jolly rant." 
Robert Boyle called one sudden outbreak "a great cold." 
Molyneux, of Dublin, mentions " a universal cold " in one year 
(1688), and "a universal transient fever" in another (1693). 
The earlier i8th century writers mostly use the word catarrh 
or catarrhal fever, either in Latin or in English, the popular 
names probably continuing fanciful as before, as for example 
Horace Walpole's " blue plagues." That which stands out 
most clearly in the English naming from the earliest times is 
the idea of something new or strange ; but the newness or 
strangeness pertained quite as much to the agues as to the 
catarrhs. The notion of ague may be said to be uppermost in 
the 1 6th and 17th centuries, that of catarrh in the i8th and 
19th; while our very latest experiences have once more brought 
a suggestion of ague to the front. 

1 Annales Monastici (St Albans), Rolls Series, No. 191, under the year 1427; 
Hist. MSS. Commiss. ix. pt. i, p. 127, records of Canterbury Abbey. — An epidemic 
in Ireland a century before, in 1328, has been given by Sir W. R. Wilde, and by 
Dr Grimshaw following him, under the name of "murre," as if that had been its 
name at the time. The explanation seems to be that the contemporary Irish name 
slaedan was rendered by Macgeoghegan, in his translation of the Annals of Clonmac- 
noise, by the 15th century English term "murre." The "mure" of 1427 was a 
universal influenza ; but the word was afterwards used for a common cold, along with 
poss, as in Gardiner's Triall of Tabacco, i6io, fol. 12 and 15 : ''stuffings in the head, 
murres and pose, coughs" ; and " the poze, murre, horsenesse, cough " etc. 

c. II. 20 



3o6 Influenzas and Epidemic Agues. 

Retrospect of Influenzas and Epidemic Agues in 
the i6th and 17th centuries. 

In the former volume of this history I have dealt with the 
various epidemics of " hot ague," " new disease " or the like 
down to the epidemic of 1657-59. ^^ will be convenient to go 
over some of that ground again, with a view to distinguish, if 
possible, the catarrhal types from the aguish, and to illustrate 
the use of the word ague as applied to a universal epidemic. 
Two of the epidemic seasons in the i6th century, 15 10 and 
1539, are too vaguely recorded for our purpose; but I shall 
review briefly the seasons from 1557-58 onwards. 

It is known from the general historians that there were two seasons of 
fever all over England in 1557 and 1558, of which the latter was the more 
deadly, the type according to Stow, being "quartan agues." In letters of 
the time the epidemic of 1557 is variously named: thus Margaret, Countess 
of Bedford, writes on 9 August from London to Sir W. Cecil that she " trusts 
the sickness that reigns here will not come to the camp [near St Ouentin, 
where Francis, Earl of Bedford was]... As for the ague, I fear not my son." 
On the 1 8th of the same month. Sir Nicholas Bacon writes from Bedford to 
Cecil: "Your god-daughter, thanks be to God, is somewhat amended, her 
fits being more easy, but not delivered of any. It is a double tertian that 
holds her, and her nurse had a single, but it is gone clearly ; " to which letter 
Lady Bacon adds a postscript about " little Nan, trusting for all this shrewd 
fever, to see her." On 21 September, it appears that the sickness had 
reached the English camp near St Quentin, for the Earl of Bedford writes : 
" Our general is sick of an ague, our pay very slack, and people grudge for 
want." As late as the 25th October the Countess of Bedford writes from 
London to Cecil that she " would not have him come yet without great 
occasions, as there reigns such sickness at London^." 

Next year, 1558, the epidemic sickness returned in the summer and 
autumn, in a worse form than before. Stow calls it " quartan agues," which 
destroyed many old people and especially priests, so that a great number of 
parishes were unserved. Harrison, a canon of Windsor, says that a third 
part of the people did taste the general sickness. On the 6th September, 
sickness affected more than half the people in Southampton, Portsmouth, 
and the Isle of Wight. From the 20th October to the end of the year, 
no fewer than seven of the London aldermen died, a number hai'dly equalled 
in the first sweating sickness of 1485, and the queen (Mary) died of the 
lingering effects of an ague, which was doubtless the reigning sickness. On 
17th October, the English commissioners being at Dunkirk to negotiate the 
surrender of Calais, one of them, Sir William Pickering, fell " very sore sick 
of this new burning ague : he has had four sore fits, and is brought very low, 
and in danger of his life if they continue as they have done." That year 
Dr Owen published A Meet Diet for the New Ague, and himself died of it in 
London on the i8th of October 2. 

Fuller quaintly describes the ague of 1558 as "a dainty-mouthed 
disease, which, passing by poor people, fed generally on principal persons of 
greatest wealth and estate^." Roger Ascham wrote in 1562 to John 

^ Cat. Cecil. MSS. I. under the dates. 

2 Munk, Roll of the College of Physicians, i. 32. 

^ Cited in Southey's Commonplace Book, from Fuller's Pisgah Sight, p. 54. 



The Epidemic Agues or Influenzas of 1557-58. 307 

Sturmius that, for four years past, or since 1558, "he was afflicted with 
continual agues, that no sooner had one left him but another presently- 
followed; and that the state of his health was so impaired and broke by 
them that an hectic fever seized his whole body; and the physicians 
promised him some ease, but no solid remedy ^" Thoresby, the Leeds 
antiquary of the end of the 17th century, found in the register of the parish 
of Rodwell, next to Leeds, a remarkable proof of the fatality of these agues, 
which fully bears out the general statements of Stow and Harrison. In 
1557 the deaths in the register rose from 20 to 76, and in 1558, which the 
historians elsewhere say was the most fatal year, they rose to 124^. This 
was as severe as the sweating sickness of 1551, for example in the adjoining 
parish of Svvillington, or in the parish of Ulverston, in Lancashire^. 

The English names of the epidemic sickness in the summers 
and autumns of 1557 and 1558 are all in the class of agues — 
" this new burning ague," " a strange fever," " divers strange and 
new sicknesses taking men and women in their heads, as strange 
agues and fevers," " quartan agues." One medical writer, Dr 
John Jones, says in a certain place that "quartans were reigning 
everywhere," and in another place, still referring to 1558, that 
he himself had the sickness near Southampton, that it was 
attended by a great sweat, and that it was the same disease as 
the sweating sickness of 1551. There were certainly two 
seasons of these agues, 1557 and 1558, the latter being the 
worst ; and it is probable from Short's abstracts of a few parish 
registers in town and country that there was a third season of 
them in 1559. The year 1557 has been made an influenza 
year, perhaps because the Italian writers have emphasized 
catarrhal symptoms here or there in the epidemic of that year; 
while both the years 1557 and 1558 have been received into 
the chronology of epidemic or pandemic agues or malarial 
fevers*. There are perhaps a dozen English references in letters 

^ Southey, Commonplace Book, from Strype's Memorials of Cramner, p. 284. 

^■Thoresby, Ducatus Leodiensis, ed. Whitaker, App. p. 152. 

^ Baines, Lattcashire, II. 679: 39 deaths from 17 to 24 August, 1551, set down to 
"plague," i.e. sweat. 

■* Lest it may be supposed that there has been adequate discussion of the 
differences between epidemic agues and influenzas, I quote from Hirsch's Handbzich 
der historisch-geographischen Pathologie the passage in which these epidemics or 
pandemics of ' ' malarial fever " are referred to : " These epidemics of malaria, which 
extend not unfrequently over large tracts of country, and sometimes even over whole 
divisions of the globe, forming true pandemics, correspond always in time with a 
considerable increase in the amount of sickness at the endemic malarious foci, 
whether near or distant ; they either die out after lasting a few months, or they 
continue — and this applies particularly to the great pandemic outbreaks — for several 
years, with regiilar fluctuations depending on seasonal influences. On the very verge 
of the period to which the history of malarial epidemics can be traced back, we meet 
with a pandemic of that sort, in the years 1557 and 1558, which is said to have 
overrun all Europe (Palmarius, De morbis contagiosis. Paris, 1578, p. 3?2)...It is not 
until the years 1678-82 that we again meet with definite facts relating to an epidemic 
.extending over a great part of Europe..." (Eng. Transl. I. 229.) 

20 — 2 



3o8 Infliienzas and Epidemic Agues. 

and chronicles to the sicknesses of those years, either to par- 
ticular cases or to a general prevalence, but they do not enable 
us to distinguish a catarrhal type in 1557 from the aguish type 
which they assert for both 1557 and 1558. 

Four years after, another very characteristic influenza was 
prevalent in Edinburgh. 

Randolph writes from Edinburgh to Cecil in the end of November, 1562: 
" Maye it please your Honer, immediately upon the Quene's (Mary's) 
arivall here, she fell acquainted with a new disease that is common in this 
towne, called here the newe acqayntance, which passed also throughe her 
whole courte, neither sparinge lordes, ladies nor damoysells, not so much as 
ether Frenche or English. It ys a plague in their heades that have yt, and 
a sorenes in their stomackes, with a great coughe, that remayneth with some 
longer, with others shorter tyme, as yt findeth apte bodies for the nature of 
the disease. The queen kept her bed six days. There was no appearance 
of danger, nor manie that die of the disease, excepte some olde folkes. 
My lord of Murraye is now presently in it, the lord of Lidingeton hathe had 
it, and I am ashamed to say that I have byne free of it, seinge it seketh 
acquayntance at all men's handes^." 

It is not improbable that the interval between 1558 and 
1562 may have been occupied with milder revivals of the 
original great epidemic, the one at Edinburgh counting in the 
series. 

It appears from a Brabant almanack for the year 1561 that 
a sudden catarrhal epidemic was quite on the cards in those 
years : the astronomer foretells for the month of September, 
1561 : "Coughs innumerable, which shall show such power of 
contagion as to leave few persons unaffected, especially towards 
the end of the months" There is an actual record from more 



1 Queen Elizabeth and he7- Times. Ed. Wright, 2 vols. Lond. 1838, i. 113. Sir 
W. Cecil writing from Westminster to Sir T. Smith on 29th December [1563] says: 
"The cold here hath so assayled us that the Queen's majestic hath been much 
troubled, and is yet not free from the same that I had in November, which they call 
a pooss, and now this Chiistmas, to keep her Majestic company, I have been newly 
so possessed with it as I could not see, but with somewhat ado I wryte this. We 
have had perpetuall frosts here sence the i6th of this month. Men doo now ordinarily 
pass over the Thamiss, which I thynk they did not since the 8th yere of the reign of 
King Henry the VIII." Ibid. i. 157. F'or " poss," see note p. 305. 

^ Ephemer. Meteorol. attni 1561 [for the latitude of Brabant]. Antwerp, 1561 : 
"Tusses numero infinitae atque tanta contagionis vi praestabunt ut pauci immunes 
reliquant, praecipue circa mensis finem." The almanacks of those times must have 
been constructed on the same principle as the weather forecasts of our own time — 
namely, that of using the experience of one year for the next, just as the weather of 
one day is an indication for the next. In 1575 Dr Richard Foster (who became 
president of the College of Physicians in 1601) issued an almanack in which he 
foretold "sweating fevers" for the month of July {Epheiner. meteorol. ad ann. 1575. 
Lond. 1575). Cogan says that Francis Keene, an astronomer, also prophesied the 
return of the sweating sickness in 1575, "wherein he erred not much, as there were 
many strange fevers and nervous sickness." 



The " Gentle Correction " of 15 80. 309 

than one country (Italy, Barcelona, as well as Edinburgh) of 
such universal catarrhs and coughs a year later than the one 
foretold. The Italian writers assign the universal catarrhs and 
coughs to the autumn of 1562, the Barcelona writer to the 
winter solstice of that year, and the letter from Edinburgh to 
" the laste of November." 

The next undoubted influenza, that of 1580, was compared 
abroad to the English sweat : 

" In some places," says Boekel, " the sick fell into sweats, flowing more 
copiously in some than in others, so that a suspicion arose in the minds of 
some physicians of that English sweat which laid waste the human race so 
horribly in 1529;" and again, "the bodies were wonderfully attenuated in a 
short time as if by a malignant sudden coUiquation, which made an end of 
the more solid parts, and took away all strength." The season of it was the 
summer. 

The outbreak attracted much attention from its universality, and was 
described by many abroad. 

Boekel says that it was of such fierceness "that in the space of six 
weeks it afflicted almost all the nations of Europe, of whom hardly the 
twentieth person was free of the disease, and anyone who was so became an 
object of wonder to others in the place. ..Its sudden ending after a month, as 
if it had been prohibited, was as marvellous as its sudden onset." It came 
up, he says, from Hungary and Pannonia and extended to Britain. The 
principal English account of this epidemic comes from Ireland^. In the 
month of August, 1580, during the war against the Desmonds, an English 
force had advanced some way through Kerry for the seizing of Tralee and 
Dingle ; " but suddenlie such a sicknes came among the soldiers, which 
tooke them in the head, that at one instant there were above three hundred 
of them sicke. And for three dales they laie as dead stockes, looking still 
when they should die ; but yet such was the good will of God that few died ; 
for they all recovered. This sicknesse not long after came into England and 
was called the gentle correction." 

This outbreak among the troops in Ireland is said to have been in 
August, before the sickness came to England. But it can be shown to have 
been at its height in London in the month of July. The year 1580 was 
almost free from plague in London ; the weekly deaths are at a uniform low 
level (a good deal below the births) from January to December, except for 
the abrupt rise shown in the following table, — the kind of rise which 
we shall see from many other instances to be the infallible criterion of an 
influenza^ : 

^ Johan Boekel, Sv^'oi/'ts novi niorbi qiiem plerique medicorum catarrhum febrilem, 
vel febrem catarrhosa7n vacant, qui non solum Gertnaniam, sed paene imiversam 
Europam graviss. adjlixit. Helmstadtii, 1580. 

^ Hoker's "Irish historic. ..to the present year 1587," p. 165a in Holinshed's 
Chronicles . 

^ This very moderate increase of the deaths in London in 1580 may be compared 
with the probably fabulous figures which Webster (i. 163) gives for continental cities 
the same year : Rome, 4000 deaths, Liibeck, 8000 deaths, Hamburg, 3000 deaths. 
I have given the weekly deaths and baptisms in London for five years, 1578-82, in 
my former volume, p. 341. 





Deaths by- 


Dead of 




ding 


all causes 


plague 


Baptised 


23 


55 


2 


59 


30 


47 


4 


57 


7 


n 


4 


65 


14 


133 


4 


66 


21 


146 


3 


61 


28 


96 


5 


64 


4 


78 


5 


73 


II 


SI 


4 


53 


18 


49 


I 


72 



310 Influenzas and Epidemic Agues. 

Weekly Deaths in London. 
1580. 



July 

It 
It 

Aug. 



As in 1557-58, the English references are to agues, both before and after 
the Gentle Correction of July-August, 1580. Cogan says that for a year or 
two after the Oxford gaol fever (1577) "the same kind of ague raged in 
a manner all over England and took away many of the strongest sort in their 
lustiest age, etc." And he seems to have the name " gentle correction" 
in mind when he says : " This kind of sickness is one of those rods, and the 
most common rod, wherewith it pleaseth God to brake his people for sin." 
Cogan's dates are indefinite. But there is a letter of the Earl of Arundel to 
Lord Burghley, 19th October, 1582, which shows that "hot ague" was 
epidemic as late as the second autumn after the influenza proper; "The air 
of my house in Sussex is so corrupt, even at this time of the year, as when I 
came away I left twenty-four sick of hot agues." 

Two such epidemics in England as those of 1557-8 and 
1580-82, of hot agues or strange fevers, taking the forms of 
simple tertian or double tertian or quartan or other of the 
classical types, would have made ague a familiar disease, and its 
name a household word. For not only were there two or more 
aguish seasons (usually the summer and autumn) in succession, 
but to judge by later experience there would have been desultory 
cases in the years following, and in many of the seizures acquired 
during the height of the epidemic, relapses or recurrences would 
have happened from time to time or lingering effects would have 
remained. Hence it is unnecessary to assume that the agues 
that v/e hear casual mention of had been acquired by residence 
in a malarious locality. They may have been, and most 
probably were, the agues of some epidemic prevalent in all 
parts of the country. These epidemics were the great oppor- 
tunities of the ague-curers, as we shall see more fully in the 
sequel. It is to the bargaining of such an empiric with a patient 
that Clowes refers in 1579: "He did compound for fifteen pound 
to rid him within three fits of his ague, and to make him as 
whole as a fish of all diseases." 

There were more sicknesses of that kind, perhaps not without 



The Agues of 1612, 311 

a sweating character, in the last ten years of the i6th century^. 
But they are indefinitely given as compared with earlier and 
later epidemics, and I shall pass to the next authentic instance. 

The autumn of 161 2 was undoubtedly a season of epidemic ague or "new 
disease" in England^. When Prince Henry, eldest son of James I., fell ill 
in November, in London, during the gaieties attending the betrothal of his 
sister the Princess Elizabeth to the Count Palatine of the Rhine, a letter- 
writer of the time said of his illness : " It is verily thought that the disease 
was no other than the ordinary ague that hath reigned and raged almost all 
over England since the latter end of summer^." The attack began in the 
end of October. The spirited and popular prince had been leading the 
gaieties in place of his father, who could not stand the fatigue, and was 
" seized by a fever that came upon him at first with a looseness, but hath 
continued a quotidian ever since Wednesday last [before the 4th of 
November], and with more violence than it began, so that on Saturday he 
was let blood by advice of most physicians, though Butler, of Cambridge, 
was loth to consent. The blood proved foul : and that afternoon he grew 

very sick I cannot learn that he had either speech or perfect memory 

after Wednesday night, but lay, as it were, drawing on till Friday between 
eight and nine of the evening that he departed. The greatest fault is laid 
on Turquet, who was so forward to give him a purge the day after he sickened, 
and so dispersed the disease, as Butler says, into all parts ; whereas if he 
had tarried till three or four fits had been passed, they might the better have 
judged of the nature of it; or if, instead of purging, he had let him blood 
before it was so much corrupted, there had been more probability." At the 
dissection, the spleen was found " very black, the head full of clear water 
and all the veins of the head full of clotted blood. Butler had the advantage, 
who maintained that his head would be found full of water, and Turquet that 
his brains would be found overflown and as it were drowned in blood*." 
Butler, it appears, was "a drunken sot." When King James asked him 
what he thought of the prince's case, he replied " in his dudgeon manner" 
with a tag of verse from Virgil ending with " et plurima mortis imago." The 
Princess Elizabeth could not be admitted to see her brother " because his 
disease was doubted to be contagious^." It was at least epidemic, for in the 
same week alderman Sir Harry Row and Sir George Carey, master of the 
wards, died "of this new disease**." The earliest reference to it that I find 
is the death, previous to 11 September, of Sir Michael Hicks at his house 
Rackholt in Essex, " of a burning ague," which came, as was thought, by his 

^ There is a curious reference to "the sweat" in Shakespeare's Measure for 
Measure, Act l. scene 2, where the bawd, in an aside, says: "Thus, what with the 
war, what with the sweat, what with the gallows, and what with poverty, I am 
custom-shrunk." It is known that Shakespeare adapted and condensed his play 
from Whetstone's Profints and Cassandra, printed in 1578, who took it from an 
Italian romance. But Whetstone's dialogue, which is pointless and verbose beside 
Shakespeare's, gives an entirely diiferent speech to the bawd at the same place in the 
action, making no reference to "the sweat." The date of Aleasure for Measure is not 
certain ; but it seems to belong to the earlier period of Shakespeare's work, when he 
was adapting old plays most freely. Whatever its date, the war, the sweat, the gallows 
and poverty are evidently topical allusions pointed enough for the audience to have 
taken up. 

^ The year 1610 is mentioned by Short as a season of universal catarrhal fever 
abroad ; but that epidemic is not in the modern chronologies of influenza. 

^ chamberlain to Carleton in Court and Times of y antes I. I. 

^ Same to saine 4 Nov. 1612. Ibid. i. p. 201. 

® Court and Times of James I. I. p. 206. ® Ibid. p. 208. 



312 Influenzas and Epidemic Agues. 

often going into the water this last summer, he being a man of years^; but 
much more probably was a case of " the ordinary ague that hath reigned 
and raged almost all over England since the latter end of summer." The 
next year was still more unhealthy, to judge by samples of parish registers ; 
agues are mentioned also in letters; thus, one going on 25 March, 1613, to 
visit Sir Henry Savile, found him " in a fit, an ague having caught hold 
of him 2." 

The winter of 1613-14 was marked by most disastrous floods in Romney 
Marsh, in Lincolnshire, in the Isle of Ely, and about Wisbech, and most of 
all in Norfolk^ ; but the malarious conditions so brought about, being subse- 
quent to, were not conceivably the cause of, the epidemics of ague in the 
autumn of 16 12 and 16 13, which made so great an excess of burials over 
christenings in the parish registers. 

A curious record remains of an aguish sickness in a child, which had 
begun about January, 1614. On 18 March, of that year, the dowager 
Countess of Arundel wrote from Sutton, near Guildford, to her son Earl 
Thomas, who was making the grand tour to Rome and elsewhere with his 
wife, and had left the children to the care of their grandmother : " Your two 
elder boys be very well and merry, but my swett Will""- continueth his tersion 
agu still. . This day we expect his twelfth fitt. I assur myselfe teeth be the 
chefe cause. I look for so spedy ending of it, he is so well and merry on his 
good days, and so strong as I never saw old nor yonge bear it so well. I 
thank Jesu he hath not any touch of the infirmity of the head, but onely his 
choler and flushe apareth, but he is as lively as can be but in the time of his 
fits onely, which continueth some eight hours*." 

The epidemic of ague or " new disease," which began to rage all over 
England in the end of the summer, 1612, had probably recurred in the years 
following, down to 161 6. There is not a trace of plague during those years 
in any known record ; and yet they are among the most unhealthy years in 
Short's abstracts of town and country parish registers^. 

The first half of the 17th century is a period which is almost 
a blank in the conventional annals of " influenza " in Europe. 
But that period, which was the period of the Thirty Years' War, 
had many widespread sicknesses. I do not wish to claim these 
as influenzas, or to contend that they were infections equivalent 
thereto in diffusiveness. We may, however, find a place for them 
in this context ; for they were certainly as mysterious as any 
epidemics admitted into the canon of influenzas. So far as con- 
cerns Britain, the first was the epidemic ague, or "new disease," 
of 161 2 and 161 3, probably recurring until 1616. The second 
was the universal spotted fever of 1623 and 1624, of which I 
have given an account in the chapter on typhus. That was 
followed by the plague of 1625, and that again by a harvest 
ague in the country in the end of the same year. The next 
epidemic ague or " general sickness, called the new disease," fell 
mostly in England upon the two years 1638 and 1639. It was 

^ Court and Times ofjfames I. p. 197. 2 /^/^, p. 237. 

^ Ibid. Letter of 25 Nov. 16 13. 
■» Cal. Coke MSS. i. 83. 



The Epidemic Agues and Influenzas of 1657-59. 313 

in part a harvest ague, " a malignant fever raging so fiercely 
about harvest that there appeared scarce hands enough to take 
in the corn*" ; but it was also a winter disease. I pass over 
the war-typhus of 1643, ^o which the name of "new disease" 
was also given, and the widespread fever of the year following. 
In 165 1 we hear again of a strange ague, which "first broke out 
by the seaside in Cheshire, Lancashire and North Wales," eighty 
or a hundred being sick of it at once in small villages. Whit- 
more, who saw this epidemic in Cheshire, identified it with the 
Protean disease which he described in 1657-58, and hazarded 
the theory that the former was a diluted or " more remiss " 
infection carried by the wind from Ireland, where the plague 
was then raging, in Dublin, Galway, Limerick and other places, 
after their sieges or occupations by the army of the Common- 
wealth, 

Thus in the first half of the 17th century we have more or 
less full evidence of epidemics of "new disease" in 161 2-1 3, 
1623-24, 1625, 1638-9, 1643-4 and 165 1, not one of which was 
an influenza as we understand the term^ 

We come at length to the years 1657-59, in the course of 
which one catarrhal epidemic, or perhaps two, did prevail for a 
few weeks. The hot agues or " new disease " had been raging 
all over the country from the summer of 1657; then in April, 
1658, there came suddenly universal coughs and catarrhs, "as if 
a blast from the stars" ; they ceased, and the hot agues dragged 
on through the summer and autumn. A letter from London, 
26 October, 1658, says: "A world of sickness in all countries 
round about London: London is now held to be the wholesomest 
place," and adds that "there is a great death of coach-horses 
almost in every place, and it is come into our fieldsl" It was 
after this, in the spring of 1659, if Whitmore has made no 
mistake in his dates, that coughs and catarrhs "universally 
infested London, scarce leaving a family where any store were, 
without some being ill of this distemper." The details have been 

1 Graunt, Obs. upon the Bills of Mortality, 1662. 

^ Robert Boyle did not attach much importance to the name of "new disease." 
"The term ne^a disease," he says, "is much abused by the vulgar, who are wont to 
give that title to almost every fever that, in autumn especially, varies a little in its 
symptoms or other circumstances from the fever of the foregoing year or season." 
(Boyle's Works. 6 vols. 1772, v. 66.) But it was the name commonly given to the 
epidemics of catarrhal fever among others, and it does not appear, when the history is 
examined closely, that it was ever given except to some epidemic separated by several 
years from the last of the kind. 

^ Sir R. Leveson's Letters. Hist. MSS. Commiss. v. 146. 



314 Infiiienzas and Epidemic Agues. 

given fully in the former volume^ I wish merely to remark 
here that the two catarrhal epidemics, or influenzas proper, in 
two successive springs, were sharply defined episodes in the 
midst of a period of epidemic agues, and that the "new disease" 
as a whole, during the two or three years that it lasted, had 
such an effect in the way of ill health and mortality that it was 
afterwards viewed as a " little plague " worthy of being set in 
comparison with the Great Plague of 1665. 

Willis does not say that the epidemic agues lasted after 
1658, perhaps because his essay was printed early in 1659; but 
Whitmore, whose preface is dated November, 1659, says, without 
distinguishing the hot ague from the catarrhal fever but speaking 
of them both as one Protean malady : " it now begins again, 
seizing on all sorts of people of different nature, which shows 
that it is epidemic." Sydenham does not appear upon the scene 
until 1661 ; but when his epidemic constitutions do begin, it is 
with intermittents or agues, which lasted, according to him, until 
1664. Perhaps if Sydenham's experience had extended back to 
1657 he would have made his aguish constitution to begin with 
that year, and to go on continuously until 1664. At all events 
it does not appear that the year 1660 was a clear interval 
between Willis's and Whitmore's period of 1657-59, ^"^^ Syden- 
ham's period of 1661-64; for it so happens that John Evelyn 
has left the following note of his own illness : 

"From 17 February to 5 April [1660] I was detained in bed with a kind 
of double tertian, the cruell effects of the spleene and other distempers, in 
that extremity that my physicians, Drs Wetherburn, Needham and Claude 
were in great doubts of my recovery." Towards the decline of his sickness 
he had a relapse, but on the 14th April " I was able to go into the country, 
which I did to my sweete and native aire at Wooton." On the 9th of May 
he was still so weak as to be unable to accompany Lord Berkeley to Breda 
with the address inviting Charles II. to assume the crown. 

Sydenham makes the " constitution " which began for him ii 
1 66 1 to decline gradually, and to end definitely in 1664, after' 
which he finds intermittents wholly absent for thirteen years, or 
until 1677. This clear interval will make a convenient break in 
the chronology, whereat we may bring in the popular and 
professional notions of ague then current, and the popular 
practice in that disease by empirics. 

1 Pp. 568-577. 



Experience of Agues got from epidemics of them,. 315 



The Ague-Curers of the 17th Century. 

It is to be observed that all the respectable writers of the 
profession speak of agues or intermittents as epidemic over the 
country for a definite period, and as disappearing thereafter for 
years together. At the same time they say little or nothing 
of the endemic malarious fevers of marshy localities. Further, 
it appears that the professed ague-curers, although they would 
wish to represent ague as a perennial disease, are really basing 
upon the same experiences of occasional epidemics which Willis, 
Whitmore and Sydenham recorded as occasional. The best 
instance of this is the ' Pyretologia ' by Drage of Hitchin. It 
was published for practice in 1665, being designed to show forth 
the author's skill as an ague-curer\ When we examine its 
generalities closely, we find that they all come from the sickly 
season of 1637, the first of those described by Willis. 

The great autumnal epidemic of that year (and the following), which 
we know from other sources to have been reckoned a "little plague," he 
describes as "a malignant sickness," which was followed in the winter by 
quartans. He himself escaped the autumnal fever but he incurred the 
quartan later in the year. In his own case, while the original paroxysm of 
this ague was still going on, a new one arose towards evening, and again, on 
the following day, a new paroxysm gathered vigour and supplanted the old, 
becoming the substantive paroxysm. Many of those who died of the quartan 
in 1657 had either the paroxysms duplicated, or a total want of them, or, in 
another passage, " the quartan which followed the autumnal disease of hetero- 
geneous quality in 1657, cut off divers old people, the fever being erratic, 
duplicated or triplicated." It was a bad sign when the quartan became 
doubled or trebled ; regularity of the paroxysm was a sign of a good 
recovery. The symptoms of a quartan are various ; but it is not easy to 
pronounce that these all are the symptoms of an intermittent fever, or the 
prodromal signs thereof, unless intermittent fevers be epidemic at the time. 
He gives the case of a civil and pious priest who had a tedious quartan from 
being struck with lightning ; he was confined to bed for two years, with loss 
of hearing, but, strangely enough, retaining the use of his eyes ; sometimes 
he was vexed with convulsions, sometimes with quartan fever. The " plebs 
medicorum" say that a quartan fever comes of melancholy, a tertian of 
choler, a quotidian of putrefied pituitous matter. The "plebs plebis" think 
that the cause is wind or flatus, and that they get rid of the ague by belching. 
In his own case he observed that if he drank more cold ale than usual, he 
was seized with distension in the loins and with palpitation, and belched up 
" flatus and crass vapours infected with the quality of a quartan." He knew 
a man who, in the fourth or fifth month of a quartan, drank wine too freely, 
so that the paroxysms came every day, and that violently ; after a week he 
had an especially severe paroxysm, and then no more for three weeks, when 
the fever returned under the type of an exquisite quartan. One case, which 
he mentions twice, led him to doubt whether quartans were not catching : a 

■^ IIiipeToXoyta sive Gtdielmi Dragei Hitchensis larpov Kal ^CKouocpov Observationes 
ah Experientia de Febribzis Iniermittentibits. Londini, 1665. 



3i6 Influenzas and Epidemic Agties. 

certain girl suffering from a quartan asked her father, who was skilled in the 
art, to open a vein ; her parent declared that during the blooding the morbid 
smell of the flowing blood reached his nostrils, so that he was seized of his 
daughter's fever at the proper time of her paroxysms, having three or four 
ague fits in due order; meanwhile the girl was free from the paroxysms for a 
whole week, but no longer. The singular nature of quartans is further 
brought out in the fact that papules, pustules and exanthems breaking out on 
the skin were quite common in the quartan fever which followed the malig- 
nant epidemic of the autumn of 1657. "In the fevers hardly any heat is 
perceived ; and so the unskilled vulgar say ' This is an ague' (Hoc est anglic^ 
Ague), and 'This is fever and ague' (Et hoc est febris et 2Si'^\Q.h Ague) when 
cold and heat are mixed equally or combined regularly." Peruvian bark does 
not evacuate the morbific matter unless by chance it provokes vomiting ; cases 
treated by it often relapse, and are not well in the intervals. Bark does not 
occur in his own prescriptions ; but he had cured many with "pentaphyllum." 
He knew several physicians in the epidemic of quartans in 1657 who trusted 
to narcotics entirely. 

Drage must have had a real experience of aguish distempers 
of one kind or another during the sickly seasons of 1657-59. 
But it is clear from the essays or advertisements of empirics 
that agues were discovered in many forms of sickness that were 
neither intermittent fevers nor fevers of any distinctive type. 
One of these practitioners in the time of Charles I. claims to be 
"the king's majesty's servant in ordinary^"; which is not in- 
credible, as Sir Robert Talbor, whom Charles 11. deigned to 
honour, was an ague-curer of the same class. 

"An ague, which hitherto amongst all sorts hath been accounted the 
physitian's shame, both for definition and cure (thus farre hath ignorance 
prevailed), but that the contrary is manifest appeareth sufficiently by this 
following definition : and shall be cured whether tertian, qum^tern or 
quotidian, by me Aaron Streater, physitian of Arts in Oxford, approved by 
Authority, the King's Majesties servant in ordinary, and dwelling against the 
Temple, three houses up in Chancerie Lane, next house to the Golden 
Anchor." An ague, he goes on, is either interpolate (intermittent) or con- 
tinual ; it is either engendered of a melancholic humour or it is a splenetic 
effect ; the liver is obstructed by abundance of choler proceeding from a salt 
rheum that cometh from the brain" etc. Agues are to be dreaded most for 
their remote effects : " Say not therefore, ' It is but an ague, but a feaver ; I 
shall wear it out.' Dally not with this disease ;" and he adds a case to show 
what people may come to if they neglect an ague at the beginning : "Being 
carried downe from London to South-hampton by Master Thomas Mason,- 
September 1640, word was brought me of a Mayd dead, 16 years of age : anc 
being requested to see what disease she dyed of, I took my chirurgion wit! 
me and went. And after section or search, I found as foUoweth : a gallor 
and a half of green water in the belly, that stunk worse than carrion ; under! 
the lyver an impostume as bigg as my fist, full of green black corrupted 
matter, and the lyver black and rot. The spleen and kidneys wholly 
decayed, and the place as black as soot ; the bowels they were fretted, ulcerated 
and rotten. In the chesse was two great handfuls of black burnt blood in 
dust or powder ; the heart was all sound, but not a drop of blood in it ; nor 
one spoonful! in the whole body. 

^ His tract is dated 1641. 



Empiric ague-ciirers, lytk centtiry. 317 

Here was an Annatomy indeed, skinne and bone; and I verily beleeve 
that there was no braine left, but that she lived while that was moyst : the 
sent was so ill, and I not well, that I forbore to search it. 

God that knowes the secrets of all hearts knowes this is a truth, and 
nothing else here written. Arthur Fauset, chirurgion at Southampton, was 
the man I employed to cut her up, as many there can witness that were 
present. 

And what of all this, may some say ? Why this. An eight weeks' ague 
in the neglect of it breeds all these diseases, and finally death." 

Let us take next the advertisement of an apothecary a 
generation after, who professed to cure Kentish agues, — " the 
description and cure of Kentish and all other agues... and 
humbly showing (in a measure) the author's judgment why so 
many are not cured, with advice in relation thereunto, whether 
it be Quotidian, Tertian or Quartan, simple, double or tripled" 
Before the Fire of London he had practised in Mark Lane, but 
after his house was destroyed he removed to Kent, attending 
Maidstone market every Thursday, and residing at Rochester, a 
city which, "besides being subject to diseases in common Vv^ith 
others, hath two diseases more epidemical, namely, the Scurvey 
for one but the Ague in special." The symptoms of scurvy, as 
he gives them, cover perhaps the one moiety of disease, and 
those of ague the other. 

Agues are of two sorts, curable and incurable ; the curable are those that 
come in a common way of Providence, the incurable those that are sent more 
immediately from God in the way of special judgment, as instances adduced 
from Scripture show. What is an ague? Some think it is a strange thing, 
they know not what ; the more ignorant think it is an evil spirit, but coming 
they know not whence. Agues have their seat in the humours either within 
the vessels or without them ; those residing within are continual quotidians, 
continual tertians, continual quartans ; those without are intermittent ditto. 
(This distinction of within and without the vessels is traditional, and is found 
in Jones's Dyall of Agues as well as in Dutch medical books a century later.) 
The paroxysms of the intermittents are really the uprising of the Archaeus 
[of van Helmont], or spirit, to oppose the rottenness of the humours. A 
quartan is harder to cure than any other ague ; part of its cure is an old 
14th-century rule of letting blood in the plague; "let blood in the left hand 
in the vein between the ring finger and the little finger, which said thing to 
my knowledge was done about sixteen years ago [to say nothing of three 
hundred years ago] by the empiric Parker in this country, with very good 
success and to his great honour and worldly advancement." This ague-curer 
says little of Peruvian bark ; his specific is the powder of Riverius, " the 
preparation of which, as well as some of the powder itself is lately and 
providentially come to my hands." Three doses cost not above five shiUings, 
"and I never yet gave more in the most inveterate of these diseases... My 
opinion is that he that will not freely part with a crown out of his pocket to 
be eased of such a disease in his body deserves to keep it." 

1 By Nicholas Sudell, licentiate in physick and student in chimistry. London, 
, 1669. 



3i8 Influenzas and Epidemic Agues. 

The most celebrated ague-curer of the Restoration period 

was Sir Robert Talbor, who thus describes the high motives 

that made him a specialist^: 

" When I first began the study and practice of Physick, amongst other 
distempers incident to humane bodies I met with a quartan ague, a disease that 
seemed to me the ne plus ultra of physic, being commonly called Ludibrium 
et Opprobrium Medicorum, folly and derision of my profession, did so 
exasperate my spirit that I was resolved to do what study or industry could 
perform to find out a certain method for the cure of this unruly distemper...! 
considered there was no other way to satisfy my desire but by that good old 
way, observation and experiment. To this purpose 1 planted myself in Essex 
near to the seaside, in a place where agues are the epidemical diseases, where 
you will find but few persons but either are, or have been afflicted with a 
tedious quartan. In this place I lived some years, making the best use of 
my time I could for the improving my knowledge." 

Talbor's first chapter is a fluent account of how agues are 
produced by " obstructions " of the spleen. This was a matter 
of theoretical pathology which an empiric could make a show 
with as well as another. But the empiric betrays himself as 
soon as he comes to practice. The enlarged spleen of repeated 
agues, or of the malarial cachexia, is commonly known as the 
ague-cake. There is no doubt that much of the unhappiness of 
the aguish habit resides in the ague-cake, and that one of the 
best pieces of treatment is to apply counter-irritants or the actual 
cautery to the left side, against which the enlarged spleen 
presses as a cake-like mass. Talbor, however, desired to free 
the patient from his " ague-cake " altogether : 

" I have observed these in four patients : two were cast out the stomach 
by nature, and the other two by emetic medicines. One of them was like a 
clotted piece of phlegm, about the bigness of a walnut, pliable like glue or 
wax, weighing about half an ounce ; another about the bigness of the yolk 
of a pullet's Qgg., and like it in colour, but stiffer, weighing about five drachms; 
the other two of a dark colour, more tough, about the like bigness, and 
heavier. It is a general observation amongst them that their ague comes 
away when they see those ague-cakes^." 

Having followed this "good old way of observation and experi- 
ment " for several years among the residents of the Essex 

^ nu/3eToXo7ta. A rational account of the Cause and Cure of Agnes, with their 
signs, Diagnostick and Prognostick. Also some Specified Medicines prescribed for the 
Ctire of all sorts of Agtces, Ssr'c. Whereiinto is added a short acconnt of the Cause and 
Cure of Feavers and the Griping in the Gnts. Autliore Rto. Talbor, Pyretiatro. 
Londini, 1672. 

^ Sir Thomas Watson {Practice of Physic, l. 725) has a story which shows how 
long these fancies, encouraged by quacks, may linger: "A coachman by whose side 
I sat while travelling from Broadstairs to Margate was speaking of the rarity of ague 
in that part of the Isle of Thanet. His father, he said, once had the complaint, and 
a fit came on while he was on a visit to him, the coachman, at Ramsgate. The son 
administered to his suffering parent a glass of l^randy; whereupon 'he threw the agy 
oflf his stomach ; and it looked for all the world like a lump of jelly.'" 



1 



Talbors practice in curing Agues. 319 

marshes, Talbor came to London, and set up his sign next 
door to Gray's Inn Gate in Holborn. In 1672 (14th July) he 
issued a small work with a Greek title — the quacks were fond 
of the Greek character on their title-pages — " TivpeToXo-^ta, a 
rational account of the cause and cure of agues, with their 
signs : whereunto is added a short account of the cause and 
cure of feavers." He made a bid also for practice in "scurvy," 
a disease of landsmen in those times which was more a bogey 
than ague itself — " a strange monster acting its part upon the 
stage of this little world in various shapes, counterfeiting the 
guise of most other diseases... sometimes it is couchant, other 
times rampant, so alternately chronic and acute." 

Most of the agues which Talbor professed to have met with 
in London in those years must have been equally factitious : 
for Sydenham, who makes more of " intermittents " than other 
writers of repute, was of opinion that, for thirteen years from 
1664 to 1677, fevers of that type had not been seen in London, 
except some sporadic cases or cases in which the attack had 
begun in the country. But the air was then full of talk and 
controversy about Peruvian bark, or Jesuits' powder {pulvis 
patrum), or " the cortex," which was cried up as a specific in 
agues by some, and cried down by others. Talbor had seized 
upon this specific, and claimed to have an original way of 
administering it, whereby its success was assured. We get a 
glimpse of his practice from Dr Philip Guide, a Frenchman who 
came to London and practised for many years as a member of 
the College of Physicians^ Talbor had cured the daughter of 
Lady Mordaunt of an ague, and the cure had reached the ears 
of Charles II. One of the French princesses having been long 
afflicted with a quartan ague, 

" The king commanded Mr Talbor to take a turn at Paris, and as a mark 
of distinction he honoured him with the title of knight. He succeeded 
wonderfully. But he could not cure Lady Mordaunt's daughter a second 
time, whom he had cured once before at London, by whom he gained most of 
his reputation." He tried for two months, but did not relieve the symptoms. 
Dr Guide was called in, and being asked to give his opinion of the ague that 
the young lady was afflicted with, " after some inquiry I found her distemper 
was complicated and quite different from the ague, which made me lay the 
thought of the ague aside, and apply myself wholly to the complicated 
disease, which I effectually cured in twelve days, together with her ague, 
without having any further need of the infallible specific of Sir Robert 
Talbor." 

1 Philip Guide, M.D., A Kind Warniitg, &=€. Lond. 1710. 



320 Influenzas and Epidemic Agues. 

The Peruvian Bark Controversy. 

It can hardly be doubted that the conflicting opinions as to 
the benefit of Peruvian bark in ague, which have been often 
cited in disparagement of medicine and as an example of its 
intolerance, arose from the indiscriminate use of it in " agues " 
diagnosed as such by quacks and pushing practitioners. The 
bark had been brought first to Spain in 1632 and had been tried 
medicinally in 1639^ It was under the powerful patronage of 
the Jesuits, especially of Cardinal de Lugo, and most of it at 
that time found its way to Rome, the centre of a malarious 
district. In 1652 it failed to cure a "double quartan" in an 
Austrian archduke, and thereafter fell into some disrepute. A 
violent controversy on its specific use in agues arose in the 
Netherlands ; it had failed in every case at Brussels, it had not 
failed in a single case at Delft. Meanwhile it remained, very 
dear, sixty florins having been paid at Brussels in 1658 for as 
much as would make twenty doses, to be sent to Paris. The 
London 'Mercurius Politicus' of the week 9-16 December, 
1658, contained an advertisement'^ that a supply of it had been 
brought over by James Thompson, merchant of Antwerp, and 
was to be had either at his own lodgings at the Black Spotted 
Eagle in the Old Bailey or at Mr John Crook's, bookseller, at 
the sign of the Ship in St Paul's Churchyard. The London 
physicians such as Prujean and Brady countenanced it, and 
Willis, in reprinting his essay on Fevers in 1660, spoke of it as 
coming into daily use. Sydenham, whose publisher was the 
same Crook at the sign of the Ship, made a brief reference to it 
in the first edition (1666) of his Observationes Medicae, in the 
section upon the epidemic constitution of intermittents during 
the years 1661-64. He admits that the bark could keep down 
fermentation for the time being ; but the inateries which the 
fermentation would have dissipated if it had been allowed its 
way, will remain in the system and quickly renew its power. 
He had known a quartan continue for several years under the 
use of bark. It had even killed some patients when given 
immediately before the paroxysm. Prudently and cautiously 
given, in the decline of such fevers, it had been sometimes 

1 The best summary of the " history of the use of Peruvian bark" is by Sir George 
Baker, in Trans. Col. Phys. \\\. (1785), 173. 

2 Cited by Baker, I.e. p. 190. 



A case of fever treated by bark, 1685. 321 

useful and had stopped the paroxysms altogether, especially if 
the aguish fits were occurring at a season when the malady was 
less epidemical. But it is clear that Sydenham in 1666 inclined 
strongly to non-interference with the natural depuratory action 
of the fever upon the niateries of the disease. His teaching 
that the cortex, while it kept down the fermentation of the 
blood for a time, left the dregs of the fever behind, was thus 
popularly stated some years after by Roger North in relating 
the fatal illness of his brother the Lord Keeper Guilford in the 
summer of 1685 \ 

The fever of Lord Guilford was not an intermittent at all, but a "burning 
acute fever without any notable remissions and no intermissions," a case of 
the epidemic typhus of that and the succeeding year, elsewhere described. 
The treatment was first in the hands of Dr Masters, pupil and successor of 
Dr Willis, whose cardinal doctrine of fevers was that they were a natural 
fermentation of the blood. He ordered phlebotomy. Next Dr Short, 
of another school, was sent for : " So to work with his cortex to take it off : 
and it was so done ; but his lordship continued to have his headache and 
want of sleep. He gave him quieting potions, as they called them, which 
were opiates to make him sleep ; but he ranted and renounced them as his 
greatest tormentors, saying 'that they thought all was well if he did not kick 
off the clothes and his servant had his natural rest ; but all that while he had 
axes and hammers and fireworks in his head, which he could not bear.' All 
these were very bad signs ; but yet he seemed to mend considerably ; and 
no wonder, his fever being taken off by the cortex. And it is now found that, 
without there be an intermission of the fever, the cortex doth but ingraft the 
venom to shoot out again more perniciously." The Lord Keeper's illness 
dragged on, and at length the physicians " found he had a lent fever which was 
growing up out of the dregs which the cortex had left ; and if it were not 
taken off, they knew he would soon perish. So they plied him with new doses 
of the same under the name of cordial powders, whereof the quantity he took 
is scarce credible ; but they would not touch his fever any more than so much 
powder of port. And still he grew worse and worse. At length the doctors 
threw up^." 

Sydenham having indicated in his edition of 1666 that bark 
was dangerous when given immediately before a paroxysm, but 
that it was sometimes useful in the decline of the fever, and 
that its benefits were greatest in those desultory agues which 
appeared at, or continued into, a season when agues had become 
less epidemical, he proceeded in his third edition of 1675 to 
enlarge these indications for giving bark in ague. He begins, as 
Talbor had begun in his essay of 1672, and as the empiric 
Streater had in his advertisement of 1641, by calling quartans 
the opprohriitm medicorum, and he then lays down precisely how 

^ Lives of the Norths. New ed. by Jessopp. Lend. 1890, in. 188. 
^ He fell into a kind of decline and died at his countiy house on 5 September, 
Dr Radcliffe having been summoned from London without avail. 

C. TI, 21 



322 Influenzas and Epidemic Agues. 

bark was to be given in those obstinate fevers, as well as in 
tertians of the aged or feeble : namely, after the fever had 
exhausted itself siio Marte, in the intervals between two 
paroxysms, an ounce of bark (in two ounces of syrup of roses) 
to be taken in the course of the two free days, a fourth part at a 
time morning and evening. The dosage may have been bor- 
rowed from Talbor, as Sir George Baker alleges^; it matters 
little for anyone's fame. Sydenham, however, in a letter of 
October, 1677, thus claimed to have been independent of Talbor 
so far as concerned the directions for giving bark which he 
inserted in his edition of 1675 : 

" I have had but few trials, but I am sure that an ounce of bark, given 
between the two fits, cures; which the physicians in London not being 
pleased to take notice of in my book, or not believing me, have given 
an opportunity to a fellow that was but an apothecary's man, to go away with 
all the practice on agues, by which he has gotten an estate in two months, 
and brought great reproach on the faculty^." 

Talbor was patronised by Charles II., who caused him to be 
made one of his physicians. On 2 May, 1678, a few months 
after the date of Sydenham's letter, Lord Arlington wrote to 
the president of the College of Physicians^: " His Majesty, 
having received great satisfaction in the abilities and success of 
Dr Talbor for the cure of agues, has caused him to be admitted 
and sworn one of his physicians." Next year, 1679, the king 
had an attack of the reigning ague, and a recurrence of it in 
1680. It is probably to the occasion of one or other of these 
attacks that an undated letter belongs from the Marquis of 
Worcester to the marchioness : " The physicians came to the 
Council to acquaint them that they intend to give the king the 
Jesuit's powder five or six times before he goes to Newmarket, 
which they agreed to. He looks well, eats two meals of meat a 
day, as he used to do'*." Evelyn has preserved a story told him 
by the Marquis of Normanby, which probably relates to the 
same aguish attack of Charles 11.^: 

^ Baker, I.e., " Had not physicians been taught by a man whom they, both abroad 
and at home, vilified as an ignorant empiric, we might at this day have had a 
powerful instrument in our hands without knowing how to use it in the most 
effectual manner." This was written at a time when physicians spoke of "throwing 
in the bark" — throwing it in "with a shovel," as an Edinburgh professor used to say. 

^ John Barker, M.l3., of Sarum, and afterwards physician to the forces, says in 
1742 (m his essay on the epidemic fever of 1741, u. s. p. 112) that he had Sydenham's 
letter in manuscript before him, and that it was written in October, 1677. 

•* Cited by Baker, 7'rans. Col. Pliys. Hi. 208. 

" Beaufort MS.S. Histor. MSS. Com. XII. App. 9, p. 85. 

" Evelyn's Diary, under the date of 29 Nov. 1694. 



i 



Theoretical and empirical viezvs of bark. 323 

" The physicians would not give the qtiinqicina to the king, at a time 
when, in a dangerous ague, it was the only thing that could cure him (out of 
envy, because it had been brought into vogue by Mr Tudor [Talbor] an 
apothecary), till Dr Short, to whom the king sent to know his opinion of it 
privately, sent word to the king that it was the only thing which could save 
his life, and then the king enjoined his physicians to give it to him, which 
they did, and he recovered. Being asked by this lord [Normanby] why they 
would not prescribe it, Dr Lower said it would spoil their practice, or some 
such expression." 

What Dr Lower was most likely to have said was, that it 
went against his principles to give bark in fevers. He was a 
physiologist, in the sense of an anatomist, the pupil of Willis at 
Oxford and his successor in practice in London. It was the 
teaching of Willis that blood was like the juice of vegetables, 
particularly the juice of the grape, in respect of fermenting, just 
as it was like milk in respect of curdling. Fever was a sudden 
access of fermentation, apt to arise in spring and autumn, from 
internal or constitutional occasions, as well as to come at any 
time by infection ; by this febrile ferment, ebullition or com- 
motion, the blood was purged of certain impurities, comparable 
to the lees of wine, which were removed from the body in the 
sweat, the urine or other critical evacuation. Jesuit's bark was 
believed to check fermentation, or, in the later phrase of Pringle 
and others, it was antiseptic ; and it was probably because he 
thought it would check the natural defaecating action of the 
blood in an ague that Lower refused to prescribe it. Sydenham 
was more tentative, pliant, empirical. He cavilled at Willis's 
doctrine of the ebullition or fermentation of the blood without 
actually rejecting it ; for he held practically the same view of 
the salutary or depuratory nature of fever, which was indeed the 
Hippocratic view of it. Accordingly in his first reference to 
bark, in 1666, he sustains the objection to it, that it interfered 
with a natural depuratory action ; and it was only in following 
the lead of Talbor, a more empirical person than himself, that 
Sydenham overcame his doctrinal scruples. Dr Short, to whom 
Charles H. sent privately for advice, was of Sydenham's party ; 
soon after that occasion, the latter dedicated to Short his 
'Tractate on Gout and Dropsy^ (1683). It was Short who 
" went to work with his cortex " upon the Lord Keeper in 1685, 
after Dr Masters, of the school of Willis, had tried his hand with 
phlebotomy. The king's experiences, a few months before the 
Lord Keeper's death, had been just the same, and with the 
same result: the deathbed of Charles II., it is well known, was 

21 — 2 



324 Influenzas and Epidemic Agues. 

the scene of ecclesiastical rivalries ; but the physicians at the 
bedside of the king had their rivalries too. 

On Monday the 2nd of February, at eight in the morning, 
the king had a seizure of some kind in his bed-chamber, which 
was currently said to have been an " apoplectic fitV although 
there is nothing said of paralysis. A letter of the 3rd February^ 
says the king " was seized in his chair and bed-chamber with 
a surprising convulsion fit which lasted three hours." Dr King, 
an expert operator who had assisted Lower in the delicate 
operation before the Royal Society on 23 November, 1667, 
of transfusing blood from one body to another, happened to 
be at hand, and, at once drawing his lancet, bled the king. His 
promptitude in action, which probably left him little time for 
diagnosis, was much applauded, and the Privy Council voted 
him a reward of a thousand pounds, which Burnet says he never 
received. 

"This rescued his Majesty for the instant," says Evelyn, (who came up 
from Wooton on hearing the news, and is probably correct in his narrative), 
" but it was only a short reprieve. He still complained, and was relapsing, 
often fainting, with sometimes epileptic symptoms, till Wednesday, for which 
he was cupp'd, let blood in both jugulars, had both vomit and purges, which 
so reliev'd him that on Thursday hopes of recovery were signified in the 
public Gazette ; but that day, about noone, the physitians thought him 
feverish. This they seem'd glad of, as being more easily allay'd and 
methodically dealt with than his former fits ; so as they prescribed the 
famous Jesuit's powder: but it made him worse, and some very able doctors 
who were present did not think it a fever, but the effect of his frequent 
bleeding and other sharp operations us'd by them about his head, so that 
probably the powder might stop the circulation, and renew his former fits, 
which now made him very weake. Thus he pass'd Thursday night with 
greate difficulty, when, complaining of a paine in his side, they drew 12 
ounces more of blood from him ; this was by 6 in the morning on Friday, and 
it gave him reliefe ; but it did not continue, for being now in much paine, 
and struggling for breath, he lay dozing, and after some conflicts, the 
physitians despairing of him, he gave up the ghost at halfe an houre after 
eleven in the morning, being 6 Feb. 1685, in the 36th yeare of his reigne, 
and 54th of his age. ...Thus died King Charles II. of a vigorous and robust 
constitution, and in all appearance promising a long life^." 

Whether the bark would have saved him if the aguish 
nature of the paroxysms (such as he had in 1679 and again in 
1680) had been clear from the first, may be doubted. But his 
chances of recovery were certainly made worse by the halting 



^ Evelyn ; Lutlrcll, i. 327. 

^ Hist. MSS. Com. v. 186. Sutlierl.ind correspondence. 

^ l^he Diary ofjohii Evelyn, under the date 4 Fell. 1685. 



Agiie-curers in the i^t/i century. 325 

and stumbling diagnosis, (according to Evelyn) — now apoplexy, 
now epilepsy, now fever^ 

The true value of cinchona bark in medicine was not seen 
until much that was vague in the use of the term " ague " had 
been swept away. In the last great epidemic period of agues 
in this country, as we shall see, from 1780 to 1786, bark was 
found, for some reason, to be ineffective. It is not in the 
treatment of epidemic agues, but of agues in malarious countries, 
that the benefits of Jesuits' bark have been from first to last 
most obvious. 

The practice in so-called agues was long in the hands of 
empirics, who, like their class in general, made business out 
of ignorant or lax diagnosis. I shall add here what remains to 
be said of specialist ague-curers in later times. They are heard 
of in London in the Queen Anne period, and as late as 1745. 

Swift writes in his Journal to Stella, 25 December, 17 10, from Bury 
Street, St James's: "I tell you a good pun: a fellow hard by pretends to 
cure agues, and has set out a sign, and spells it egoes ; a gentleman and I 
observing it, he said, 'How does that fellow pretend to cure agues?' I 
said, I did not know, but I was sure it was not by a spell. That is ad- 
mirable." In 1745, Simon Mason, of Cambridge, published by subscription 
and dedicated to Dr Mead an essay, The Nature of an Intermitting Fever 
and Ague considered (Lond. 1745), in which he has the following on " charm- 
doctors" : — " When one of these poor wretches apply to a doctor of this 
stamp, he enquires how many fits they have had ; he then chalks so many 
strokes upon a heater as they tell him they have had fits, and useth some 
other delusions to strengthen the conceit of the patient" (p. 167). Francis 
Fisher, who had been upper hostler in a livery stable in Crutched Friars near 
forty years, " told me he seldom missed a week without several ague patients 
applying to him, and he cured great numbers by a charm they wore in their 
bosoms" (p. 239). Another, who kept a pubfic-house near St George's 
Fields, Southwark, sold "febrifuge ale" at a shilling a pint. It was a small 
ale brewed without hops, but with bark, serpentery, rhubarb and cochineal 
mixed in the brewing. The receipt was given him by an old doctor who was 
a prisoner in the King's Bench. His customers came in the morning fasting, 
and drank their shilling's worth after the publican had given them faith by a 
cordial grip of the hand. " By this means," he told Mason, " I got a good 
trade to my house, and a comfortable maintenance too." 

We may now return to the actual history of the epidemic 
fevers upon which the Peruvian bark was first tried on a large 
scale in England. The " intermittent " constitution which began 
in 1677 ^i^d lasted year after year until 1781 or even longer was 

^ The popular imagination at the time appears to have been most impressed by 
Dr King's promptitude in whipping out his lancet. Roger North must have had it 
incorrectly in his mind when he wrote : " About the time of the death of Charles II., 
it grew a fashion to let blood frequently, out of an opinion that it would have saved 
his life if done in time." 



326 Influenzas and Epidemic Agnes. 

a very remarkable one. It was called at the time the new fever, 
or the new ague, and it had at least one short interlude of 
influenza or epidemic catarrhal fever in the winter of 1679, just 
as the last epidemic of the kind, in 1657-59, had at least one, 
and probably two, short and swift epidemic catarrhs in spring. 
But before we come to that epidemic of 1678-81, there falls 
to be noticed an epidemic in the month of November, 1675, 
which has always been counted among the influenzas proper. 
After giving the particulars of it from Sydenham and from the 
London bills of mortality, I shall show from Sydenham and 
the bills of mortality that there was an exactly similar epidemic 
in the month of November, 1679, which has not been admitted 
into the conventional list of influenzas. Thereafter I shall 
proceed to the epidemic constitution of 1678-81 as a whole, 
which has been reckoned among the epidemic agues or malarious 
epidemics. 

The Influenza of 1675. 

The first that we hear of the universal cold of 1675 is an 
entry which Evelyn makes in his diary under 15 October: 
" I got an extreme cold, such as was afterwards so epidemical 
as not only to afflict us in this island, but was rife over all 
Europe, like a plague. It was after an exceeding dry summer 
and autumn." It was not until November that the epidemic 
cold made an impression upon the death-rate in London ; the 
deaths mounted up from 275 in the week ending 2 November, 
to 420 and 625 in the two weeks following, and thereafter 
gradually declined to an ordinary level. Part of the excess, 
but by no means the greater part of it, was set down under 
fevers, as the following section from the weekly bills of the year 
will show : 

1675 









Griping in 




Week Ending 


Fever 


Smallpox 


the Guts 


All causes 


Nov. 2 


42 


9 


29 


275 


9 


60 


12 


42 


420 


16 


130 


13 


43 


62s 


23 


99 


2 


28 


413 


30 


61 


6 


29 


349 


Dec. 7 


54 


7 


25 


308 


14 


43 


5 


12 


266 



This shows the characteristic rise and fall of an epidemic 



Sydenham on the Epidemic Cold of i6y$. 327 

catarrh both in the article of fever deaths and in the column 
of deaths from all causes. The other excessive articles besides 
fever in the two worst weeks are also characteristic of influenza 
mortality : 





Week ending 
9 Nov. 


Week ei 
16 Nc 


Consumption 

Aged 

Tissick 


68 
40 
10 


67 

35 



Sydenham's account bears out the figures \ At the end of 
October, he says, the mild, warm weather turned to cold, while 
catarrhs and coughs became more frequent than at any time 
within his memory. They lasted until the end of November, 
when they ceased suddenly. Afterwards he gives a special 
chapter to the "Epidemic Coughs of the year 1675, with 
Pleurisies and Pneumonias supervening." The epidemic spared, 
he says, hardly anyone of whatever age or temperament ; it 
went through whole families at once. A fever which he calls 
febris comatosa had been raging far and wide since the beginning 
of July, with which in the autumn dysenteric and diarrhoeal 
disorders were mingled (it was an exceedingly dry season). 
This constitution held the mastery all the autumn, affecting 
now the head, now the bowels, until the end of October, when 
catarrhs and coughs became universal and continued for a 
month. Sydenham's view of the sequence of events was his 
usual one, namely, that one constitution, by change of season, 
passed by transition into another. Whatever the constitution of 
" comatose " fevers may have been, which prevailed " far and 
near," it has left no trace upon the bills of mortality in London, 
which are remarkably low until the beginning of November. 
But as soon as the epidemic of coughs begins, the weekly 
deaths mount up in an unmistakeable manner, so that for two 
or three weeks in November, the mortality is nearly double that 
of the weeks preceding or following. 

The "severe cold and violent cough," of 1675, says Thoresby 
of Leeds^, who was then a boy, " too young or unobservant to 



^ Obs. Med. 3rd ed. 1675, V. 5. 

2 Ralph Thoresby, Ducatus Leodiensis, ed. Whitaker, App. p. 151. Brand, Bisl. 
of Newcastle, under the year 1675, says that "the jolly rant" caused 724 deaths in 
that town, the authority given being Jabez Cay, M.D., who left his papers to 
Thoresby. The number given is probably the mortality from all causes. 



328 Influenzas and Epidemic Agues. 

make such remarks as might be of use," was known in the north 
of England "profanely" by the name of the "jolly rant." 
Thoresby well remembered that it affected all manner of persons, 
and that so universally that it was impossible, owing to the 
coughing, to hear distinctly an entire sentence of a sermon. He 
gives December as the month of it in Leeds, and says that it 
affected York, Hull, and Halifax, as well as the counties of 
Westmoreland, Durham, and Northumberland. In Scotland 
also we find a trace of a strange epidemic sickness. It was the 
' time of the persecution of the Covenanters, whose preachers 
moved hither and thither among the farm-houses. One of 
them, John Blackadder, was at the Cow-hill in the parish of 
Livingstown in August, 1675. He came in one evening from 
the fields very melancholy, and in reply to questions, he said 
he was afraid of a very dangerous infectious mist to go through 
the land that night. He desired the family to close doors and 
windows, and keep them closed as long as they might, and 
to take notice where the mist stood thickest and longest, for 
there they would see the effects saddest. "And it remained 
longest upon that town called the Craigs, being within their 
sight, and only a few families ; and within four months 
thereafter, thirty corpses went out of that place \" The 
prophecy was fulfilled within four months, which would bring 
us to the date of the influenza, although the mortality for a 
small place is somewhat excessive. 



The Influenza of 1679. 

For the sake of comparison, I pass at once to an epidemic of 
coughs and colds in the month of November, 1679, which 
Sydenham has chronicled, but no one except Cullen^ has 
thought of including among the influenzas. It produced the 
characteristic effect of influenza on the London weekly bills, and 
it came in the midst of epidemic agues, just as the epidemic 
catarrhs of 1658 and 1659 ^^-^ done. The following rise and 
fall are just as distinctive of an influenza as on the last occasion 
in 1675 : 

^ Patrick Walker's Life of Cargi//, pp. ■29, .',0. 

-' Synopsis Nosologiae. 3rd ed. Ediu. 1780, il. 173. 



Sydenham on the Epidemic Cold of 1679. 329 

1679 









Griping of 




Veek ending 


Fever 


Smallpox 


the Guts 


All causes 


Nov. II 


50 


18 


34 


328 


18 


89 


27 


39 


541 


25 


126 


21 


55 


764 


Dec. 2 


82 


27 


38 


457 


9 


63 


12 


38 


388 



Sydenham's account^ of this remarkable November outburst 
of sickness in London, written within a few weeks of its 
occurrence, is almost exactly a repetition of his language 
concerning the epidemic coughs of November, 1675. The 
prevailing intermittent fevers, he says, gave place to a new 
epidemic depending upon a manifest crasis of the air. The 
new epidemic was one of coughs, which were so much more 
general than at the same season in other years that in nearly 
every family they affected nearly every person. In some cases 
of the cough, the aid of a physician was hardly needed ; but 
in others the chest was so shaken by the violent convulsive 
cough as to bring on vomiting, and the head was affected with 
vertigo. For the first few days the cough was almost dry, and 
so purely paroxysmal as to remind Sydenham of the whooping- 
cough of children. Everyone was surprised, he says, at the 
frequency of these coughs in this season. His own suggestion 
was that the rains of October^ had filled the blood with crude 
and watery particles, that the first access of cold had checked 
transpiration through the skin, and that Nature had contrived 
to eliminate this serous colluvies either by the branches of the 
" vena arteriosa " or (as some will have it) by the glands of the 
trachea, and to explode it by the aid of a cough. Phlebotomy 
and purging were the best cures ; diaphoretics he considered less 
safe, and he ascribed to their abuse the fever into which some 
fell, and the pleurisies which were apt to attack patients with 
great violence during the subsidence of the epidemic catarrh. 

The Epidemic Agues of 1678-80. 

The other English writer on the epidemic constitution of 
1678-79 is Dr Christopher Morley^ Like Sydenham, he is 

^ Epist. respotts. ad R. Brady, § 42. 

^ Luttrell {Diary, I. 23) enters under Oct. 1629: "About the middle of this 
month vast great rains fell which have been very prejudicial! to many persons." 

* Christopher Love Morley, M.D., De Morbo Epideinico tatn hujus qua7ti superioris 
Anni, id est 1678 et 1679 Narratio. Preface dated London, 31 Dec. 1679. 



33'^ Influenzas and Epidemic Agues. 

occupied almost exclusively with the epidemic agues ; but he 
also records the extraordinary rise of the mortality in London 
for a few weeks in the last months of the year, and the causes 
thereof, although it did not occur to him to count that as a 
separate part of "the new disease," still less as the principal part, 
which it really was in London so far as concerned the death-rate. 
Dating his preface from London, the 31st of December, 1679, he 
says in the text: "Within the very days of my present writing, it 
happens that as many as four hundred deaths more than usual 
have taken place in a fortnight," the excessive mortality having 
been due to "coryza, bronchitis, catarrh, cough and fever," which 
were the effects of " most pernicious destinations." 

I shall now go back to the beginning of the epidemic 
constitution in the midst of which this November interlude 
occurred, and I shall follow it season after season to the end, so 
as to set forth in historical prominence that which was regarded 
at the time as " the new disease." When Sydenham returned to 
London in the autumn of 1677, after six months' rest from 
practice, he was told by his professional friends that intermittents 
were being seen here and there (after a clear interval of thirteen 
years), being more frequent in the country than in the city. In 
the letter of October, 1677, cited above, he speaks of Talbor 
having made a fortune in two months by his cures of agues with 
bark. 

The first particular notice of the " new fever " occurs in a London letter 
of 23 February, i6X| : " Lady Katherin Brudenhall has been in great danger 
of death by the new feaver^" A severe aguish illness of Roger North, fully 
described in his 'Autobiography,' was probably another instance of the 
reigning malady; it came upon him in the hot weather of 1678, while he was 
residing with his brother, Lord Guilford, at Hammersmith^. In the autumn 
of 1678, the "new fever" came more into notice. On the 8th of September, 
a letter was brought to Evelyn in church, from Mr Godolphin (afterwards 
celebrated as the minister of William III.), to say that his wife was exceed- 
ingly ill and to ask Evelyn's prayers and assistance. Evelyn and his wife 
took boat at once to Whitehall, and found the young and much-beloved 
Mrs Godolphin " attacqu'd with the new fever then reigning this excessive 
hot autumn, and which was so violent that it was not thought she could last 
many hours." She died next day, in her twenty-ninth year ; but, as she had 
been brought to bed of a son six days before, her fever may have been more 
from puerperal causes than from " the new fever then reigning." Other 
known cases of ague the next season were those of Sir James Moore, his 
majesty's engineer, who, in August, 1679, coming from Portsmouth " was 
seized with an ague, and had two or three violent fits, which carried him 
off'';" and of the king, Charles II., who was congratulated on his recovery 

' Lady Chawortli to Lord Rocs, Calendar of the Bclvoir MSS. Ii. 47. 

- Lines of the Nortlis. Ed. cit. in. 143. 

^ LwiUQWv, Historical Relation. Oxford, 1S57, i. 19. 



The Epidemic Agues of 1678-81. 331 

by the lord mayor and aldermen, on 15 September, and had a recurrence of 
the aguish attack ("two or three fits") on 15 May, 1680I. There are also 
references to the agues of 1679 i'^ the country, in the letters of Lady 
North 2. 

Sydenham wrote his account of this epidemic of intermittents 
in compliance with a request from Dr Brady, Master of Gonville 
and Caius College, Cambridge, that he would continue the 
method of his ' Observationes Medicae ' into the years following, 
and in particular give an account of his method of administering 
bark. He occupied most of his space with treatment ; but he 
gives here and there the following epidemiological details. The 
agues were mostly tertians, or quotidians, or duplex forms of these, 
whereas on a former occasion they had been mostly quartans ; 
after two or three intermissions they were apt to become 
continual fevers. The agues, which had occurred in the spring 
of 1678, became more common in the summer and autumn, 
when they raged so extensively that no other disease deserved 
the name of epidemic so much. In winter smallpox took the 
lead ; but early in July, 1679, the agues began again, and so 
increased day by day that in August they were raging ex- 
cessively and destroying many. It was in August that the king 
had his " great cold " at Windsor, which afterwards changed to 
an ague. Sydenham then comes to the November interlude of 
epidemic catarrhs, which was followed by "a fever without cough" 
{non peiiitus deleta, sed manente adhuc in sanguine, nialae crasis 
impressione^, lasting to the beginning of 1680. As that year 
wore on, the intermittent fevers began again, and continued 
more or less until 1685, becoming indeed less common in 
London, and less severe, than in the first four years of the 
constitution, but in other places, now here, now there, not less so 
than at first ^ 

1 Luttrell, loc. cit. i. 20, 21, 44. 

^ On 16 March, the illness of "little Frank... hath made me suspect some kind of 
aguish distemper ; but, if it be, it is so little that we neither perceive coming nor 
going." On 7 July, another child is recovered of her feverish distemper. On 
5 October, " all my little ones are very well, but some of my servants have quartan 
agues." Lives of the Norths, Letters of Anne, Lady North. 

^ An authentic case of these lingering epidemic agues was that of John Evelyn in 
the beginning of 1683. On 7th Febraary, 1687, he writes: "Having had several 
violent fits of an ague, recourse was had to bathing my legs in milk up to the knees, 
made as hot as I could endure it ; and sitting so in a deep churn or vessel, covered 
with blankets, and drinking carduus posset, then going to bed and sweating. I not 
only missed that expected fit, but had no more, only continued weak that I could not 
go to church till Ash Wednesday, which I had not missed, I think, so long in twenty 
years" — in fact, since his "double tertian" in 1660, which kept him in bed from 
17th February to 5th April. 



332 Influenzas and Epidemic AgiLes. 

I have kept to the last the special account of this epidemic 
written by Morley at the end of the second year of it, namely, in 
December, 1679. He had been a witness of this fever, first at 
Leyden in the autumn of 1678, and next in England in the 
autumn of 1679, and he made it the subject of a treatise at the 
request of an eminent physician in London. It was not so 
severe by half in England as in Holland, but the English made 
a great deal more of it, calling it the New Disease, the New 
Ague, the New Fever, the New Ague Fever, and, in Derbyshire 
sarcastically, the New Delight In Holland they called it 
neither new nor old, neither intermittent nor continued, nor a 
conjunction of both, but simply morbus epidemictis, or febris 
epidemica. His master at Leyden, Professor Lucas Schacht, 
taught very decidedly that it was of a scorbutic nature, and as 
early as the month of June, 1678, had prophesied the arrival of 
such an epidemic fever because "tertians were becoming more 
and more scorbutic," just as they had done before the great 
epidemic of fever in Holland in 1669. Morley claims, however, 
that the fever of 1678 was in some respects different from that 
of 1669, as well as from that of the year immediately preceding, 
1677, when "an incredible multitude of people all over Belgium, 
and in every city and town, fell sick." The Dutch, it appears, 
called these occasional outbreaks simply " the epidemic fever," 
neither intermittent nor continued ; and certainly that of 1669, 
which is sometimes counted among the epidemic agues, was a 
very remarkable " ague." (See Chapter I. p. 19.) 

The epidemic fever of 1678, wherever it may have been 
bred or engendered, was prevalent in England at the same time 
as in Holland — in an exceedingly hot and dry autumn. The 
most constant symptoms, says Morley (and he writes both for 
Holland^ in 1678 and for the country districts of England in the 
autumn of the following year), were nausea, severe vomiting, 
incredible tightness about the breast, weight in all the limbs, 
weariness, giddiness, vigils, thirst, restless tossing, and languor 
remaining after the disease was gone. Among the more re- 
markable symptoms were the following: Many had aphthae of 
the mouth, some twice or thrice, some being endangered by the 
severity and closeness of the patches of thrush. In some there 

^ Ralph Thoresby caught it at Rotterdam, suffered from it, in the tertian form, for 
several weeks of Octoljer and November, 1678, and brought it home with him to 
Leeds. He gives a good account of the illness in his Diary (2 vols. Lond. 1S30). 



The epidemic of 1678-79 in Holland and England. 333 

occurred bleeding from the nose, or from piles, stranguary, etc. 
Round worms were observed, issuing both by the mouth and 
anus. In some few there were spots on the skin, but hardly ever 
petechiae or tumours near the ears. It affected all classes equally, 
all ages and both sexes. Some said it was easier to children 
than to adults, but others denied this. Some said it was more 
pernicious in the country than in the towns. In Leyden, the 
deaths never exceeded 150 in the week, being about twenty in a 
week above the ordinary level. More died from the coughs, 
anginas, peripneumonies and pleurisies that followed, than from 
the disease itself. Schacht says that the wind for nearly two 
years had been steadily from the North, or veering to the East 
or West. The Leyden faculty, and the Dutch generally, did 
not think the disease a malignant one ; it was very freely called 
so, however, in England, the chorus being led by empirics and 
illiterate persons : "Ac indicio est," says Morley, " libellus perexi- 
guus nostra lingua ab Empirico conscriptus de hoc morbo." 
This seems to refer to the tract by one Simpson, which I shall 
notice briefly^ 

Simpson styles himself a Doctor of Physic, and denies that he is an 
empiric. One sign of his affinity to that order, however, is that he objects to 
the orthodox treatment — emetics, drenches, a too coohng regimen, and 
purges, while he thinks blood-letting of doubtful utility. The symptoms 
were chills at the outset, pains in the head and back (in some with shaking), 
then intense burning heat, thirst, profuse immoderate sweats and great 
debility, a general lassitude, dulness, and stupor which in many were 
followed by delirium and a comatose state. Sometimes the fever simulated 
a quotidian, sometimes a tertian. He calls it "this new fever so grassant in 
city and country" and says that in many it assumed " the guise of a morbus 
cholera, known by the much vomitings or often retchings to vomit ; and in 
others under the livery of the gripes with looseness, or, in some, looseness 
without gripes." This choleraic tendency concurring with other usual causes 
from the late season of fruit-eating etc., had swelled the bills of mortality. 
The morbus cholera and the gripes were to the new fever " like the circum- 
joviales that move in the same sphere with (but at some distance from) their 
master-planet." 

The meaning of all this is obvious on turning to the London 
weekly bills of mortality. In the months of August and 
September for three years in succession, 1678-80, the deaths 
from " griping in the guts " and from " convulsions " rose greatly. 
These were, indeed, three successive seasons of fatal diarrhoea, 
mostly infantile, as I shall show in the chapter on that disease. 

^ The History of this present Fever, with its tiuo prodticts, the Morlms Cholera and 
the Gripes. By W. Simpson, Doctor in Ph5'sick. London, 1678. 



334 Iiifliie7isas and Epidemic Agnes. 

The following extracts from the London weekly bills of 
mortality show how " fevers," as well as other diseases, con- 
tributed to the great rise in the autumns of 1678, 1679, and 
1680. 

Atitumnal London Mortality in 1678. 
1678 









Griping 




Week ending 


Fever 


Smallpox 


in Guts 


All causes 


Aug. 20 


n 


31 


87 


459 


27 


79 


37 


130 


510 


Sept. 3 


82 


37 


121 


53° 


10 


103 


27 


164 


621 


17 


82 


23 


178 


580 


24 


83 


20 


152 


528 


Oct. I 


82 


25 


117 


485 


8 


77 


27 


106 


456 



Summer and Autumnal London Mortality in 1679. 
1679 









Griping 




Week ending 


Fever 


Smallpox 


in Guts 


All causes 


July 22 


42 


55 


lOI 


442 


29 


60 


50 


134 


565 


Aug. 5 


78 


63 


143 


531 


12 


62 


43 


161 


579 


19 


55 


64 


149 


545 


26 


68 


53 


112 


514 


Sept. 2 


96 


40 


97 


466 


9 


92 


47 


75 


471 


16 


85 


50 


87 


462 


(For the 


Influenza 


weeks, see 


former Table 


•) 


Autitinnal London Mortality in 1680. 








1680 


Griping 




Week ending 


Fever 


Smallpox 


in Guts 


All causes 


Aug. 10 


70 


17 


108 


427 


17 


90 


6 


132 


494 


24 


98 


17 


127 


552 


. 31 


140 


18 


228 


816 


Sept. 7 


lOI 


14 


215 


671 


14 


94 


13 


173 


635 


21 


106 


9 


175 


628 


28 


130 


9 


159 


615- 


Oct. 5 


125 


16 


138 


597 


12 


121 


10 


94 


530 


19 


109 


14 


68 


488 


26 


93 


5 


58 


407 


Nov. 2 


77 


10 


53 


396 



The last of the three autumnal seasons, 1680, is one of the 
few in the bills with high deaths from fever along with high 



Country mortalities during tJie aguish period. 335 

deaths from choleraic disease; and that excess of fever mortality 
may have been due in part to the ague epidemic, then in its third 
season. 

The following extracts from Short's summation of parish 
registers show the great excess of burials over baptisms in 
various parts of England during the years of the aguish epidemic 
constitution. 

Country Parishes. 





Registers 


Sickly- 


Baptisms 


Burials 


Year 


examined 


parishes 


in do. 


in do. 


1678 


136 


17 


312 


527 


1679 


m 


44 


800 


1203 


1680 


137 


54 


1093 


1649 


1681 


137 


41 


679 


1 1 56 


1682 


140 


30 


632 


975 




Market Towns. 








Registers 


Sickly 


Baptisms 


Burials 


Year 


examined 


parishes 


in do. 


in do. 


1678 


22 


5 


578 


789 


1679 


23 


7 


877 


I37I 


1680 


24 


7 


946 


1494 


1681 


24 


9 


945 


1333 


1682 


25 


9 


795 


1092 


1683 


25 


8 


1 109 


.1398 


1684 


25 


8 


865 


1243 


1685 


25 


4 


741 


II9I 



The Influenza of 1688. 

The seasons continued, according to Sydenham, to produce 
epidemic agues until 1685, when the constitution radically 
changed to one of pestilential fevers, affecting many in all ranks 
of society and reaching a height in 1686. Sydenham records 
nothing beyond that date, having shortly after fallen into ill 
health and ceased to write or even to practise. One would wish 
to have known what he made of the "new distemper" in the 
summer of 1688, for it was a sudden universal fever, and yet not 
a catarrh or a " great cold." It is thus referred to in a letter of 
the month of June, from Belvoir, Rutlandshire^: "The man 
that dos the picturs in inemaled is gon up to London for a weke 
...I wish the man dos not get this new distemper and die before 
he comes agane." On turning to the London weekly bills of 

1 Cal. Belvoir MSS. 11. 120. June, 1688. Bridget Noel to the Countess of 
Rutland. 



33^ Influenzas and Epidemic Agues. 

mortality we find in the first weeks of June the characteristic 
rise of one of those sudden epidemic fevers or new diseases, of 
which the earliest with recorded figures was the "gentle cor- 
rection" of July, 1580. The following are the weekly London 
figures corresponding to the " new distemper" of 1688 : 



Weekly 


London Mortalities. 
1688 




Week ending 


Fevers All causes 


May 29 
June 5 


58 
76 


368 

518 


12 

19 
26 


lOI 
65 

66 


559 
435 
437 



The contemporary London notice of this "influenza" comes 
from Dr Walter Harris, who mentioned it in a book written the 
year after': 

" From the middle of the month of May in the year 1688, for some weeks, 
a slight sort of fever became epidemical. It affected the joints of the 
patients with slight pains, and they complained of a pain in their heads, 
especially in the fore-part, and of a sort of giddiness. It was more rife than 
any that I ever observed before, from any cause whatsoever, or in any time 
of the year. A great many whole families were taken at once with this 
fever, so that hardly one out of a great number escaped this general storm. 
Now this so epidemical or febrile insult seemed plainly to me to depend 
upon the variety of the season of the year, the most intense heat of some 
days being suddenly changed to cold... Never were so many people sick 
together : never did so few of them die. They recovered under almost any 
regimen, — almost everyone of them." 

It will be seen, however, that the bills rose very considerably 
for four weeks, and that, too, in the healthiest season of the year. 

A somewhat fuller account of its symptoms is given by 
Molyneux for Dublin^ He had been informed by a learned 
physician from London that it had been as general there as in 
Dublin, which we know to have been the case from Harris's 
account. Both Molyneux and Harris call it a slight fever, 
without mentioning catarrhal symptoms. The spring months 
immediately preceding had been remarkable for drought. 

At Dublin this "short sort of fever" was first observed about the begin- 
ning of July, or some six weeks later than in London. "It so universally 
seized all sorts of men whatever, that I then made an estimate not above one 
in fifteen escaped. It began, as generally fevers do, with a chilness and 

^ Walter Harris, M.D., De 7norbis acutis infantum. Lond. 1689. English 
transl, by Cockburn, 1693, p. 88. 

^ "Historical Account of the late General Couf^lis and Colds, with some Observa- 
tions on other Epidemical Distempers." Phil. Trans. XVIII. (1694), p. 109. 



Molyneux on the epidemic " short fever" of 1688. 337 

shivering all over, like that of an ague, but not so violent, which soon broke 
out into a dry burning heat, with great uneasiness that commonly confined 
them to their beds, where they passed the ensuing night very restless ; they 
commonly complained likewise of giddiness, and a dull pain in their heads, 
chiefly about the eyes, with unsettled pains in their limbs, and about the 
small of their back, a soreness all over their flesh, a loss of appetite, with a 
nausea or aptness to vomit, an unusual ill taste in their mouths, yet little or 
no thirst. And though these symptoms were very violent for a time, yet 
they did not continue long : for after the second day of the distemper the 
patient, usually of himself, fell into a sweat (unless 'twas prevented by letting 
blood, which, however beneficial in other fevers, I found manifestly retarded 
the progress of this) : and if the sweat was encouraged for five or six hours 
by laying on more cloaths, or taking some sudorifick medicine, most of the 
disorders before mentioned would entirely disappear or at least very much 
abate. The giddiness of their head and want of appetite would often 
continue some days afterwards, but with the use of the open fresh air they 
certainly in four or five days at farthest recovered these likewise and were 
perfectly well. So transient and favourable was this disease that it seldom 
required the help of a physician ; and of a thousand that were seized with it, 
I believe scarce one dyed. By the middle of August following, it wholly 
disappeared, so that it had run its full course through all sorts of people in 
seven weeks time. ..This fever spread itself all over England; whether it 
extended farther I did not learn." 

This short fever of men was preceded by a slight but 
universal horse-cold \ 

The Influenza of 1693. 

Molyneux considered the strange transient fever of the 
summer of 1688 to have been the most universal fever that 
perhaps had ever appeared, and he thought the universal catarrh 
of five years' later date (1693) to have been "the most universal 
cold." We have thus a means of contrasting in the descriptions 
of the same author a universal slight fever and a universal 
catarrh, which happened within five years of each other, and 
were neither of them called at the time by the name of influenza, 
— a name not known in Britain until half a century later. 
Before coming to Molyneux's description, it should be said that 
the London bills of mortality bear no decided trace of an 
influenza in the end of the year 1693, the following being the 
highest weekly mortalities nearest to the date given for the 
epidemic at Dublin"'^: 

^ " 'Twas very remarkable that in England as well as this kingdom a short time 
before the general fever, a slight disease, but very universal, seized the horses too : in 
them it showed itself by a great defluxion of rheum from their noses ; and I was 
assured by a judicious man, an officer in the arnay of Ireland, which was then drawn 
out and encamped on the Curragh of Kildare, there were not ten horses in a regiment 
that had not this disease." Molyneux, u. s. 

^ Evelyn says nothing of a great epidemic cold in this season, but makes the 
following remarks on the weather : " Oct. 31. A very wet and uncomfortable season. 

C. II. 22 



338 



Influenzas and Epidemic Agues. 

London Weekly Mortalities. 
1693 



Week ending 


Fever 


All causes 


)ctober 10 


43 


353 


17 


62 


353 


24 


SI 


384 


31 


69 


457 


November 7 


68 


455 


14 


48 


365 



Molyneux's account of the flying epidemic of 1693 is as 
follows^ : 

" The coughs and colds that lately so universally prevailed gave us a 
most extraordinary instance how liable at certain times our bodies are, 
however differing in constitution, age and way of living, to be affected much 
in the same manner by a spreading evil,..'Twas about the beginning of 
November last, 1693, after a constant course of moderately warm weather 
for the season, upon some snow falling in the mountains and country about 
the town [Dublin], that of a sudden it grew exti-emely cold, and soon after 
succeeded some few days of very hard frost, whereupon rheums of all kinds, 
such as violent coughs that chiefly affected in the night, great defluxion of 
thin rheum at the nose and eyes, immoderate discharge of the saliva by 
spitting, hoarseness in the voice, sore throats, with some trouble in swallowing, 
whesings, stuffings and soreness in the breast, a dull heaviness and stoppage 
in the head, with such like disorders, the usual effects of cold, seized great 
numbers of all sorts of people in Dublin. 

" Some were more violently affected, so as to be confined awhile to their 
beds ; those complained of feverish symptoms, as shiverings and chilness all 
over them, that made several returns, pains in many parts of their body, 
severe head-aches, chiefly about their foreheads, so as any noise was very 
troublesome : great weakness in their eyes, that the least light was offensive; 
a perfect decay of all appetite; foul turbid urine, with a brick-coloured 
sediment at the bottom ; great uneasiness and tossing in their beds at night. 
Yet these disorders, though they very much frightened both the sick and 
their friends, usually without help of remedy would abate of themselves, and 
terminate in universal sweats, that constantly reheved...When the cold was 
moderate, it usually was over in eight or ten days; but with those in whom 
it rose to a greater height, it continued a fortnight, three weeks, and some- 
times a month. One way or other it universally affected all kinds of men; 
those in the country as well as city ; those that were much abroad in the 
open air, and those that stay'd much within doors, or even kept close in their 
chambers ; those that were robust and hardy, as well as those that were weak 
and tender — men, women and children of all ranks and conditions. ..Not one 
in thirty, I may safely say, escaped it. In the space of four or five weeks it 
had its rise, growth, and decay; and though from first to last it seized such 
incredible numbers of all sorts of men, 1 cannot learn that any one truly 
dyed of it, unless such whose strength was before spent by some tedious fit 
of sickness, or laboured under some heavier disease complicated with it. .It 
spread itself all over England in the same manner it did here, particularly it 
seized them at London and Oxford as universally and with the same 
symptoms as it seized us in Dublin ; but with this observable difference that 

Nov. 12. The season continued very wet, as it had nearly all the summer, if one 
might call it summer, in which there was no fruit, but corn was very plentiful." 
' Molyneux, Phil. Trans, xviii. (1694), p. 105. 



A slight epidemic f eve 7' in 171 2. 339 

it appeared three or four weeks sooner in London, that is, about the 
beginning of October... Nor was its progress, as I am credibly informed, 
bounded by these Islands for it spread still further and reached the Continent, 
where it infested the northern parts of France (as about Paris) Flanders, 
Holland, and the rest of the United Provinces with more violence and no less 
frequency than it did in these countries." 

Yet no other writer, English or foreign, appears to have 
mentioned it. -. Its existence rests on the authority of Molyneux 
alone, according to the above very circumstantial narrative. 



The Influenza of 1712. 

There were so many fevers from 1693 to the end of the 
century that it is not easy to distinguish epidemic agues or 
catarrhs among them. If we follow the continental writers, it is 
not until 1709 and 17 12 that there is any concurrence of 
testimony for such widespread maladies. Evelyn, however, says 
that in the remarkably dry and fine months of February and 
March, 1705, "agues and smallpox prevail much in every place" 
(21st February). The very general coughs and catarrhs of 1709 
seem to have been really caused by the severity of the me- 
morable hard winter, the frost having begun in October, 1708 
and lasted until March, 1709. The evidences of a truly epidemic 
infectious catarrh or influenza all over Europe in 1709 are scanty 
and ambiguous. It is probably to this " universal cold " that 
Molyneux refers under the year 1708^; but English writers have 
not otherwise mentioned an epidemic in 1709. 

The next, in 17 12, was a "new ague" of the kind without 
catarrhal symptoms, like that of 1688, One German writer 
called it the " Galanterie-Krankheit," another the " Mode- 
Krankheit," and it was about the same time that the French 
name " la grippe " came into use. These names all mean " the 
disease a la mode" or the reigning fashion 2; they remind one of 
the earlier "trousse galante" and "coqueluche" (a kind of 
bonnet), and of the " grande gorre " of 1494. It appears to 
have made little or no impression on the mortality, and would 
hardly have been noticed but for its wide prevalence. In 

^ "An universal cold that appeared in 1708, and was immediately preceded by a 
very sudden transidon from heat to cold in Dublin and its vicinity." Molyneux's 
Memoirs. 

^ La Grippe may, of course, be taken literally to mean seizure ; but the common 
use of the word seems to have been figixrative for some fancy that seized many at once 
and became the fashion. 

22 — 2 



340 hifluenzas and Epidemic Agues. 

England it was the subject of a brief essay by Dr John Turner 
under the title of " Febris Britannica Anni 1712^" — a certain 
epidemic fever, of the milder kind, fatal to none, but prevalent 
far and wide and leaving very few families untouched. It was 
marked by aching and heaviness of the head, burning or lanci- 
nating pains in the back, pains in the joints like those of 
rheumatism, loss of appetite, vomiting, pains of th6 stomach and 
intestines. The venom though not sharp, acted quickly. Turner 
ascribed it to malign vapours from the interior of the earth 
{malignos terrae matris halit7is). Its season in England, as in 
Germany, was probably the summer or autumn. Turner begins 
his discourse with a reference to the plague in the East of 
Europe, which, he says, had been kept out of England by 
quarantine, to the murrain which was then raging in Italy (and 
appeared in England in 17 14), and to fevers of a bad type which 
had traversed all France during the past spring, invading noble 
houses and even the royal palace. Having begun his discourse 
thus, he ends it by remarking that the slight British fever did 
not, in his opinion, forebode a plague to follow. It may have 
been a recurrence of this epidemic next year that Mead speaks 
of under the name of the " Dunkirk rant " (supposed to have 
been brought over from Dunkirk by returning troops after the 
Peace of Utrecht) in September, 17 13; it was, he says, a mild 
fever, which began with pains in the head and went off easily in 
large sweats after a day's confinement I The weekly bills of 
mortality in London are no help to us to fix the date of the one 
or more slight fevers or influenzas about 17 12-13. The great 
fever-years of the period were 17 10 and 17 14; but the fever 
was typhus, probably mixed with relapsing fever, according to 
the evidence in another chapter. Even compared with the 
universal fever or influenza of 1688, that of 171 2 must have 
been unimportant ; for the former sent up the London mortality 
considerably, whereas there is no characteristic rise to be found 
in any month of 1712 or 1713. 

^ Joannes Turner, M.D., De Febre Britannica Antti 17 12. Lond. 17 13, pp. 3, 4. 

'^ Mead, Short Discourse concerning Pestilential Contagion. Lond. 1720, p. 8. 
But Short, who wrote in 1749, places the "Dunkirk rant" under the year 17 10: {Air, 
Weather^ ^c. I. 455). — " March i, began and reigned two months an epidemic which 
missed few, and raged fatally like a plague in France and the Low Countries, and was 
brought by disbanded soldiers into England, namely a catarrhous fever called the 
Dunkirk rant or Dunkirk ague... It lasted eight, ten, or twelve days. Its symptoms 
were a severe, short, dry cough, quick pulse, great pain of the head and over the 
whole body, moderate thirst, and sweating. Diuretics were the cure." 



Agues occasional in Scotland. 341 

Either to this period, or to the undoubted aguish years 
1727-28, belongs a curious statement as to "burning agues, 
fevers never before heard of to be universal and mortal," in 
Scotland, the same having been a " sad stroke and great distress 
upon many families and persons," The authority is Patrick 
Walker, who traces these hitherto unheard of troubles to the 
Union of the Crowns {I'jo'jy. 

On other and perhaps better authority, it does appear that 
Scotland before that period was reputed to be remarkably free 
from agues ; and it is probable that the universal and mortal 
burning agues some time between 1707 and 1728, had come in 
one of those strange epidemic visitations, just as the agues of 
1780-84 did. It would be erroneous to conclude from such 
references to ague that Scotland had ever been a malarious 
country. Robert Boyle refers in two places to the rarity of 
agues in Scotland in the time of Charles II. ; the Duke of York, 
he says^ on his return out of Scotland, 1680, mentioned that 
agues were very unfrequent in that country, " which yet that year 
were very rife over almost all England " — to wit, the epidemic 
of 1678-80. Again, agues, especially quartans, are rare in 
many parts of Scotland, " insomuch that a learned physician 
answered me that in divers years practice he met not with above 
three or four^" However, Sir Robert Sibbald, while he admits 
the rarity of quartans, does allege that quotidians, tertians and 
the anomalous forms occurred, that agues might be epidemic 
in the spring, with different symptoms from year to year, and 
that certain malignant fevers, not called agues, were wont to 
rage in the autumn*. 

Epidemic Agues and Influenzas, 1727-29. 

The contemporary annalist of epidemics in England is 
Wintringham, of York, who enters remittents and intermittents 
almost every year from 1717 to the end of his first series of 

^ "The effects and evidences of God's displeasui'e appeai-ing more and more 
against us since the incorporating union [1707], mingling ourselves with the people of 
these abominations, making ourselves liable to their judgments, of which we are deeply 
sharing ; particularly in that sad stroke and great distress upon many families and 
persons, of the burning agues, fevers never heard of before in Scotland to be universal 
and mortal." Life and Death of Alexander Peden. 3rd ed. 1728. Biog. Presb. 
I. 140. 

^ Boyle's Works. Ed. 1772, v. ']^i,. 

* Ibid. V. 49. 

* Scotia niustrata. Edin. 16S4. Lib. II. " De Morbis," p. 52. 



342 Influenzas and Epidemic Agues. 

annals in 1726 ; but none of his entries points very clearly to an 
epidemic of ague\ It is not until the very unwholesome years 
1727-29 that we hear of intermittent fevers being prevalent 
everywhere, with one or more true influenzas or epidemic 
catarrhs interpolated among them. To show how unhealthy 
England was in general, I give a table compiled from Short's 
abstracts of the parish registers, showing the proportion of 
parishes, urban and rural, with excess of burials over chris- 
tenings : 

Country Parishes. 



Year 


Registers 
examined 


Registers 

showing high 
death-rate 


Births 
in ditto 


Deaths 
in ditto 


1727 
1728 
1729 
1730 


180 
180 
178 
176 


55 
80 
62 
39 


IO91 
1536 
1442 
1022 


1368 
2429 
2015 
1302 




Market Towns. 






Year 


Registers 
examined 


Registers 

showing high 

death-rate 


Births 
in ditto 


Deaths 
in ditto 


1727 
1728 
1729 
1730 


33 
34 
36 
36 


19 

23 
27 
16 


2441 
2355 

3494 
2529 


3606 

4972 
6673 

3445 



It is clear from the accounts by Huxham, Wintringham, 
Hillary, and Warren, of Bury St Edmunds^, that much of the 
excessive sickness in 1727-29 was aguish, although much of 
it, and probably the most fatal part of it, was the low putrid 
fever so often mentioned after the first quarter of the i8th century. 
At Norwich, where the burials for three years, 1727-29, were 
nearly double the registered baptisms, many were carried off, 
says Blomefield, " by fevers and agues, and the contagion was 
general." In Ireland also, a country rarely touched by true 
agues, Rutty enters intermittent fever as very frequent in May, 
1728; and again, in the spring of 1729: "Intermittent fevers 
were epidemic in April ; and some of the petechial kind. Nor 
was this altogether peculiar to us ; for at that same time we 
were informed that intermittent and other fevers were frequent 

1 Commentar. Nosolog. Lond. 1727. 

^ The Method and Manner of curing the late raging Fevers, and of the danger, 
uncertainty and timvholesomcness of the Jestiifs bark. Dated 6 Dec. 1728: "You 
see that intermitting fevers, when they come to be chronical (and you may see it 
almost everywhere) make room for a great many distempers, and those very difficult 
to cure." p. 49. 



The Influenza of 1729. 343 

in the neighbourhood of Gloucester and London ; and very- 
mortal in the country places, but less in the cities." 

In the midst of this epidemic constitution of agues and other 
fevers there occurred one or more horse-colds, and one or more 
epidemic catarrhs of mankind. The most definitely marked 
or best recorded of these was the influenza of 1729. 

The universal cold or catarrh of 1729 fell upon London in 
October and November, and upon York, Plymouth and Dublin 
about the same time. It prevailed in various parts of Europe 
until March, 1730, its incidence upon Italy being entirely after 
the New Year. The rise in the London deaths was character- 
istic : the level was high when the epidemic began, but the 
epidemic nearly doubled the already high mortality during the 
worst week and trebled the deaths from " fever." 



London Weekly Mortalities. 






1729 




Week ending 


Fever All causes 


October 21 


88 


564 


28 


118 


603 


November 4 


213 


908 


II 


267 


993 


18 


166 


783 


25 


124 


635 



The high mortalities of the weeks following may be taken 
as due to the sequelae of the epidemic (pneumonias, pleurisies, 
malignant fevers) and are indeed so explained in one con- 
temporary account : 



ending 


Fever 


All causes 


aber 2 


92 


678 


9 
16 


132 
116 


779 
707 


23 
30 


123 
109 


710 
628 



The influenza of October and November, 1729, was the occasion 
of a London essay \ which appears to treat solely of the 
epidemic catarrh and its after-effects, and not of the two years' 
previous sicknesses, which are the subject of another essay, 
by Strother, written before the influenza began, London, says 

^ An Enquiry into the Causes of the Present Epidemical Diseases, viz. Fevers, 
Coughs, Asthmas, Rheumatisms, Defiuxions, &'c. By the author of "The Family 
Companion for Health." London, 1729, pp. 6, 7. 



344 Infliienzas and Epidemic Agues. 

this author, as well as Bath, and foreign parts, have been on 
a sudden seized universally with the disorders named in his 
title (fevers, coughs, asthmas, rheumatisms, defluxions etc.). 
These had come in the course of an unusually warm and wet, 
or relaxing, winter ; " we have for some time past dwelt in fogs, 
our air has been hazy, our streets loaden with rain, and our 
bodies surrounded with water." So many different symptoms 
attend the " New Disease " that a volume, he says, would not 
suffice to describe them, but he thus summarizes them : 

Sudden pain in the head, heaviness or drowsiness, and anon their noses 
began to run; they coughed or wheezed, and grew hoarse; the)^ felt an 
oppression and load on their breasts, and turned vapourish, either because 
they apprehended ill consequences, or because their spirits were oppressed 
, with a load of humours. The victims of the epidemic, he says again, were 
very subject to vapours ; they are, upon the least fatigue or emotion of mind, 
dispirited, and flag upon every emergency. Among other symptoms were, 
quick pulse, thirst, loss of appetite and vertigo : the mouth and jaws hot, 
rough and dry, the thrush raising blisters thereon ; the throat hoarse ; a 
fierce brutal cough, which weakens by bringing on profuse sweats ; the 
urine, muddy and white, "if they who are seized have been old asth- 
maticks." 

He speaks of cases that had proved suddenly fatal and says 
that all who died of " epidemical catarrhs " had been found 
to have polypuses in their hearts. If reference be made to the 
Table, it will be seen that the high mortality continued in 
London for at least a month after the epidemic had passed 
through its ordinary course of rise, maximum and decline ; and 
it is probably to that post-epidemic mortality that the author 
refers in the following passages : 

" Numbers, as appears by our late bills, are taken with malignant fevers, 
or malignant pleurisies or with pleuritic fevers.... Whosoever, then, would 
prevent a defluxion from turning into a fever, or from anything yet worse, if 
worse can be, must keep warm and observe a diluting regimen so long as till 
their water subsides and the symptoms are vanquished...! am convinced by 
experience that many poor creatures have perished under these late epi- 
demical fevers, from the fatal mistake of never retiring from their usual 
employments till they have rivetted a fever upon them, and till they have 
neglected twelve or fourteen days of their precious time." This was fully 
endorsed by Huxham for the influenza of 1733 : " Morbus raro lethalis, quern 
tamen, multi, vel ob ipsam frequentiam, temeri spernentes, seras dedere 
poenas stultitiae, asthmatici, hectici, tabidi." 

Hillary's account for Ripon is very brief* : 

" The season continuing very wet, and the wind generally in the southern 
points, about the middle of November [1729] an epidemical cough seized 

^ "Variations of the weather and Epicl. Diseases, 1726-34 at Ripon." Appendix 
tu Essay on the Smallpox. Lend. 1740, p. 35. 



A probable Influenza in 1728. 345 

almost everybody, few escaping it, for it was universally felt over the kingdom ; 
they had it in London and Newcastle two or three weeks before we had it 
about Ripon." 

Wintringham, of York, says the epidemic in the early winter 
of 1729 was "a febricula with slight rigors, lassitude, almost 
incessant cough, pain in the head, hoarseness, difficulty in 
breathing, and attended with some deaths among feeble persons, 
from pleuritic and pulmonary affections^" There was a tradition 
at Exeter as late as 1775 that two thousand were seized in one 
night in the epidemic of 1729. Huxham, of Plymouth, says of 
the epidemic in November : 

" A cartarrhal febricula, with incessant cough, slight dyspepsia, anorexia, 
languor, and rheumatic pains, is raging everywhere. When it is more 
vehement than usual, it passes into bastard pleurisy or peripneumony ; but 
for the most part it is easily got rid of by letting blood and by emetics." In 
December, the coughs and catarrhal fever continued, while mania was more 
frequent than usual, and in January, 1730, the cartarrhal fever still infested 
some persons. 

Rutty, of Dublin, merely says : "In November raged an 
universal epidemic catarrh, scarce sparing any one family. It 
visited London before us^" 

These references to the unusual catarrhal febricula in 
November, 1729, are all that occur in the epidemiographic 
records kept by some four British writers who recorded the 
weather and prevalent diseases of those years. The epidemic 
catarrh made a slight impression upon them beside some other 
epidemics, and hardly a greater impression than another of the 
same kind, which seems to have occurred in the beginning of 
1728. Thus, Rutty says, under November, 1727 : " In Stafford- 
shire and Shropshire their horses were suddenly seized with a 
cough and weakness. In December, it was in Dublin and remote 
parts of Ireland ; some bled at the nose." On December 25th, 
he enters : " The horses growing better, a cough and sore throat 
seized mankind in Dublin^" Huxham, for Devonshire, under 
Oct.-Nov. 1727 confirms this: "a vehement cough in horses, 
which lasted to the end of December ; the greater number at 
length recovered from it." He does not say in that context 

^ Comment. Nosol. p. 142. 

" This epidemic appears to have made a much greater impression in Italy. The 
Political State of Great Britain for 1730, p. 172, under the date of 12th January, N.s. 
speaks of " the influenza, a strange and universal sickness and lingering distemper," 
as causing thirty deaths a day in the public hospital of Milan, as well as fatalities at 
Rome, Bologna, Ferrara and Leghorn, including the deaths of two cardinals. 

* Chronological History, p. 10. 



346 Influenzas and Epidemic Agues. 

that an epidemic cough followed among men, as Rutty does say 
for Dublin ; but in a subsequent note upon horse-colds, he 
says : "In 1728 and 1733 it [the precedence of the horse-cold] 
was most manifest ; in which years a most severe cough seized 
almost all the horses, one or two months earlier than men." 
From which it would appear that the influenza of Nov.-Dec. 
1729, was not the only one during the aguish years 1727-29. 

In the weekly London bills the other series of mortalities 
that look most like those of an influenza are in the month of 
February, 1728 (748, 889, 850 and 927 in four successive weeks, 
being more than double the average). 



The Influenza of 1733. 

The next influenza was three years after that of 1729 — in 
January, 1733. In London, it raised the weekly deaths for a 
couple of weeks to a far greater height than the preceding had 
done. Also the purely catarrhal symptoms of running from the 
eyes and nose are more prominent in the accounts for 1733 than 
for the influenza of 1729. The first notice of it comes from 
Edinburgh. The horses having been "attacked with running 
of the nose and coughs towards the end of October and beginning 
of November," the same symptoms began suddenly among men 
on the 17th December, 1732/. By the 25th the epidemic was 
general in Edinburgh, very few escaping, and it continued in 
that city until the middle of January, 1733. In a great many it 
began with a running of lymph at the eyes and nose, which 
continued for a day. Generally the patients were inclined to 
sweat, and some had profuse sweats. It was noted as remarkable 
that the prisoners in the gaol escaped ; also the boys in 
Heriot's Hospital, as well as the inhabitants of houses near to 
that charity. The Edinburgh deaths rose as in the following 
table ; the bulk of these extra burials are said to have been at 
the public charges, the epidemic having swept away a great 
number of poor, old, and consumptive people : 

^ Edinburgh Medical Essays and Obsa-vations, il. p. 22, Art. 2. "An Account 
of the Diseases that were most frequent last year in Edinburgh" (June, 1832 to May, 
1833): There liad been tertian agues throughout the month of June, 1732, and from 
August to October an epidemic in the suburbs and villages near lidinburgh, of a slow 
fever, having symj^toms like the "comatose" fever of Sydenham, or tlie remittent of 
children. 



The Influenza of 1732-33. 347 

Buried in November, 1732 89 

„ „ December, 1732 109 

„ „ January, 1733 214 

„ „ February, 1733 135 

Hillary^ fixes the date of its beginning at Leeds on 3 February, 
one week later than at York, three weeks later than at 
Newcastle, or than in London and the south of England 
generally. At Leeds in three days' time about one-third part 
of the people were seized with chills, catarrh, violent cough, 
sneezing and coryza ; the epidemic lasted five or six weeks in 
the town and country near. Dr John Arbuthnot, who was then 
living in Dover Street, is clear that the outbreak in London was 
later than in Edinburgh, which indeed appears also from the 
paragraph in the Gentleman s Magazine, dated Wednesday the 
nth January, and from a comparison of the dates of highest 
mortalities in London (p. 349) and Edinburgh. It was in Saxony 
from the 15th November to the 29th of that month, and in Hol- 
land before it broke out in England. But it had begun in New 
England in the middle of October, and had broken out soon 
after in Barbados, Jamaica, Mexico and Peru. Its outbreak 
in Paris was at the beginning of February, 1733, and at Naples 
in March. The symptoms, says Arbuthnot, were uniform in 
every place — small rigors, pains in the back, a thin defluxion 
occasioning sneezing, a cough with expectoration. In France 
the fever ended after several days in miliary eruptions, in 
Holland often in imposthumations of the throat. In some, the 
cough outlasted the fever six weeks or two months. The horses 
were seized with the catarrh before mankind^. 

The account of the influenza of 1733 in London in the Gentleman'' s 
Magazine is under the date of 1 1 January : " About this time coughs and 
colds began to grow so rife that scarce a family escaped them, which carried 
off a good many, both old and young. The distemper discovered itself by a 
shivering in the limbs, a pain in the head, and a difficulty of breathing. The 
remedies prescribed were various, but especially bleeding, drinking cold 
water, small broths, and such thin liquids as dilute the blood ^." 

Huxham says that it was in Cornwall and the west of Devon in 
February, 1733, and that at Plymouth, on the loth of that 

1 op. cit. p. 47. 

^ John Arbuthnot, M.D. , Essay concerning ttie Effects of Air on Human Bodies. 
London, 1733, p. 193. His remarks upon the "hysteric" maladies that were 
common after the wave of mfluenza in Jan. -Feb. 1733, are referred to in the chapter 
on Continued Fevers, along with the corresponding information from Hillary, of 
Ripon. 

* Gent. Magaz. 1733, Jan. p. 43. 



348 Injiiienzas and Epidemic Agues. 

month, some were suddenly seized : " the day after they fell 
down in multitudes, and on the i8th or 20th of March, scarce 
anyone had escaped it." 

It began with slight shivering, followed by transient erratic heats, head- 
ache, violent sneezing, flying pains in the back and chest, violent cough, a 
running of thin sharp mucus from the nose and mouth. A slight fever 
followed, with the pulse quick, but not hard or tense. The urine was thick 
and whitish, the sediment yellowish-white, seldom red. Several had 
racking pain in the head, many had singing in the ears and pain in the 
meatus auditorius, where sometimes an abscess formed : exulcerations and 
swelling of the fauces were likewise very common. The sick were in general 
much given to sweating, which, when it broke out of its own accord and was 
very plentiful, continuing without striking in again, did often in the space of 
two or three days carry ofl" the fever. The disorder in other cases terminated 
with a discharge of bilious matter by stool, and sometimes by the breaking 
forth of fiery pimples. It was rarely fatal, and then mostly to infants and 
old worn out people. Generally it went off about the fourth day, leaving a 
troublesome cough often of long duration, " and such dejection of strength as 
one would hardly have suspected from the shortness of the time." The 
cough in all was very vehement, hardly to be subdued by anodynes : and it 
was so protracted in some as to throw them into consumption, which 
carried them off within a month or two^. 

Huxham is unusually full on the coughs and anginas of 
horses for several months before the influenza of men. In 
August, 1732, coughs were troubling some horses ; in Septem- 
ber, a coughing angina (called "the strangles") everywhere 
among horses which almost suffocates most of them ; in October 
the disease of horses is raging at its worst ; and in December it 
is still amonsf them. 



The Influenza of 1737. 

After several years, unhealthy in other ways, the influenza 
came again in the autumn of 1737. In Devonshire, according 
to Huxham, the horses began to suffer from cough and angina, 
and some of them to die, as early as January, 1737, the epizootic 
being mentioned again in February, but not subsequently. The 
same observer says the influenza began at Plymouth in No- 
vember and lasted to the end of December, 1737, seizing almost 
everyone, and proving much more severe than the epidemic 
catarrhal febricula of 1733". In London it must have begun in 
the end of August, to judge by the characteristic rise in the 
weekly bills, and in the item of "fevers" more especially; and 

' Huxham, Obs. de aere el i/iorliis rpidcinicis, i']2^-f^2, Ply/tiuthi fac/ac. 
'^ De Acre, ^c. pp. 3, 136-8, 



The Influejiza of 1737. 



349 



although the deaths kept high for a longer period than in 1733, 
yet no single week of 1737 had much more than half the highest 
weekly mortality of the preceding influenza season. 





London Weekly Mortalities. 






1733 




All 


1737 




All ■ 


Week ending 


Fevers 


causes 


Week ending 


Fevers 


causes 


January 16 


69 


531 


August 30 


117 


611 


23 


83 


783 


September 6 


161 


720 


30 


243 


1588 


13 


201 


837 


February 6 


170 


1 166 


20 


229 


861 


13 


IIO 


628 


27 


167 


770 


20 


66 


591 


October 4 


143 


687 








II 


114 


551 



In Dublin the worst week's mortality in 1737, in the month 
of October, was 144, whereas in the influenza of 1733 the highest 
weekly bill had been only 98^ Hardly any particulars of the 
influenza of 1737 remain, although it appears to have been 
widely difi"used, being recorded for Barbados and New England. 
The only source of English information is Huxham of Plymouth, 
who mentions some symptoms which should serve to characterize 
this outbreak, namely : violent swelling of the face, the parotids 
and maxillary glands, followed by an immense discharge of an 
exceedingly acrid pituita from the mouth and nose ; toothache 
and, in some, hemicrania ; " in multitudes," wandering rheumatic 
pains ; in others violent sciatics ; in some griping of the bowels. 
Huxham makes one interesting statement: "This catarrhal fever 
has prevailed more or less for several winters past ; " or, in other 
words, the interval between the severe influenza of 1733 and the 
milder influenza of 1737 was not altogether clear of the disease. 
He adds that it put on various forms, according to the different 
constitutions of those it attacked. 



The Influenza of 1743. 

Six years after, in 1743, came another influenza, which 

presents some interesting points. A writer in the Gentleman' s 

Magazine for May, 1743, says that the epidemic began in 

September last in Saxony, that it progressed to Milan, Genoa, 

•^ and Venice, and to Florence and Rome, where it was called the 

^L Influenza; in February last (1743) no fewer than 80,000 were 

I 



' Rutty, Chronol. Hist, of Diseases in Dublin. Lond. 1770. 



350 Infijienzas and Epidemic Agues. 

sick of it [? in Rome] and 500 buried in one day. At Messina it 
was suspected to be the forerunner of a plague — which did, 
indeed, ensue. It is now (May) in Spain, depopulating whole 
villages. The outbreak in Italy is authenticated by many 
notices collected by Corradi, Brescia having had the epidemic in 
October, 1742, Milan and Venice in November, Bologna in 
December, Rome, Pisa, Leghorn, Florence and Genoa in January, 
1743, Naples and the Sicilian towns in February. The English 
troops, in cantonments near Brussels, were little touched by it 
when it reached that capital about the end of February, but, 
strangely enough, "many who in the preceding autumn had been 
seized with intermittents then relapsed \" 

In London the epidemic appears to have begun in the end of 
March, and had trebled the deaths in the week ending 12th 
April ; by the beginning of May it was practically over. 

London Weekly Mortalities. 





1743 




Week ending 


Fevers 


All causes 


March 29 


94 


579 


April 5 


189 


1013 


12 


300 


1448 


19 


223 


1026 


26 


IIS 


629 


May 3 


82 


537 



The familiar view of the influenza in London is given in a 

letter by Horace Walpole from Arlington Street, 25 March, 

1743': 

" We have had loads of sunshine all the winter : and within these ten 
days nothing but snows, north-east winds and blue plagues. The last ships 
have brought over all your epidemic distempers ; not a family in London 
has scaped under five or six ill ; many people have been forced to hire new 
labourers. Guernier, the apothecary, took two new apprentices, and yet could 
not drug all his patients. It is a cold and fever. I had one of the worst, 
and was blooded on Saturday and Sunday, but it is quite gone ; my father 
was blooded last night ; his is but slight. The physicians say there has 
been nothing like it since the year thirty-three, and then not so bad [the bill 
of mortality almost the same] ; in short our army abroad would shudder to see 
what streams of blood have been let out ! Nobody has died of it [as yet, 
but later some 1000 in a week above the usual bill] but old Mr Eyres 
of Chelsea, through obstinacy of not bleeding ; and his ancient Grace of 
York ; Wilcox of Rochester succeeds him, who is fit for nothing in the world 
but to die of this cold too." 

^ Pringle, Diseases of the Army, p. i6. 

^ Letters of Horace Walpole, ed. Cunningham, i. 235. 



The Influenza of 1743. 351 

The account in the Gentleman s Magazine confirms the 
vast shedding of blood : "In the last two months it visited 
almost every family in the city ; so that the surgeons and all the 
phlebotomists had full employment. Bleeding, sweating and 
blistering were the remedies usually prescribed. All over the 
island it cut off old people. At Greenwich upwards of twenty 
hospital men and boys were buried in a nights" In Edinburgh, 
as in London, the weekly burials were trebled. On Sunday, 
May 6th, fifty sick persons were prayed for in the Edinburgh 
churches, and in the preceding week there had been seventy 
burials in the Greyfriars, being three times the usual number^ 
It reached Dublin in May, proving milder and less fatal than in 
London (perhaps that is why the writer in the Gentleman s 
Magazine says it did not visit Ireland at all) ; it visited, also, 
the remote parts of Ulster and Munster, scarce sparing a 
family ^ 

It had reached Plymouth in the end of April. Huxham, 
who is again the chief witness to its symptoms, says that it was 
much less severe there than in the south of Europe or even than 
in London. 

Innumerable persons were seized at once with a wandering kind of 
shiver and heaviness in the head ; presently also came on a pain therein, as 
well as in the joints and back; several, however, were troubled with a 
universal lassitude. Immediately there ensued a very great and acrid de- 
fluxion from the eyes, nostrils and fauces, and very often falling upon the 
lungs, which occasioned almost perpetual sneezings, and commonly a violent 
cough. The tongue looked as if rubbed with cream. The eyes were 
slightly inflamed ; and, being violently painful in the bottom of the orbit, 
shunned the light. The greater part of the sick had easy, equal and kindly 
sweats the second or third day, which, with the large spitting, gave relief. 
Great loss of strength, however, remained. Frequently towards the end of 
this " feveret," several red angry pustules broke out : often, likewise, a 
sudden, nay a profuse, diarrhoea with violent griping. In many cases 
Huxham was astonished at the vast sediment (yellowish white), which the 
urine threw down, " than which there could not be a more favourable 
symptom*." One remarkable feature of the epidemic of 1743 was recalled by 
W. Watson in a letter to Huxham on the epidemic of 1762 : " In the disorder 
of 1 743 the skin was very frequently inflamed when the fever ran high ; and 
it afterwards peeled off" in most parts of the body^." 

^ Gent. Magaz. xiii. May 1743, p. 272. 

^ R. Chambers, Domestic Annals of Scotland, iii. 610. 

* Rutty, u. s. under the year 1 743. In an earlier passage, he says that the 
influenza of 1743 raised the Dublin weekly bills to a highest point of 67, so that it 
must have been very slight in that city. 

* Huxham, Obs. de acre etc., 2nd ed. 3 vols. Lond. 1752-70, 11. 99. 
■' W. Watson, Phil. Trans, lh. 646. 



352 Infljteiizas and Epidemic Ag7ies. 

Some Localized Influenzas and Horse-colds. 

For the space of nineteen years, from 1743 to 1762, there 
occurred no universal cold common to all the countries of 
Europe ; the convergence of positive testimony, which is so 
remarkable on many occasions from the i6th century onwards, 
is found on no occasion during that interval. And yet the 
period is not wanting in instructive notices of epidemic catarrh, 
which I shall take from English writings only. British troops 
occupied Minorca during some of those years, and the epidemics 
of the island were carefully noted by Cleghorn. Under the year 
1748 he writes : 

" About the 20th April there appeared suddenly a catarrhal fever, which 
for three weeks raged so universally that almost everybody in the island was 
seized with it. This disease exactly resembled that which was so epidemical 
in the year 1733. For in most part of the sick the feverish symptoms went 
off with a plentiful sweat in two or three days ; while the cough and 
expectoration continued sometime longer. In a few athletic persons, who 
were not blooded in tiine, it terminated in a fatal pleurisy or phrensy^." 

Another English epidemiographist, Hillary, who had begun his 
records at Ripon, was in those years resident in Barbados ; and 
in that island, as in Minorca, we hear of unmistakeable universal 
colds, although none of them at the same time as the one 
recorded by Cleghorn. The Barbados annalist records a general 
catarrhous fever in September, 1752"*, and a recurrence of the 
same in the end of December, lasting until February 1753 
(catarrh and coryza, cough, hoarseness, a great defluxion of 
rheum, some having fever with it). As it ceased in February, 
1753, a slow nervous fever began, and continued epidemic for 
eighteen months, until September, 1784, when it totally dis- 
appeared, and was not seen again so long as Hillary remained in 
the island (1758). In 1755 there was another epidemic catarrhal 
fever, first in February and again in the end of the year. In the 
earlier outbreak, few escaped having more or less of it, the 
symptoms being cold ague for a few hours, followed by a hot 
fever with great pain in the head, or pains in the back and all 



^ Cleghorn, Observations on the Epidemical Diseases in Minorca, 1744-49, p. 132. 

^ This influenza was observed in the North American Colonies. It is noteworthy 
that Huxham, of Plymouth, records under Octol)er, 1752, that hundreds of people at 
once had cough, sore throat, defluxions from the nose, eyes and moutli, attended with 
a slight fever, and more or less of a rash, several having a great flux of the belly. — 
On Ulcerous Sore 7"hroat, 1757, p. 13. 



An Influenza confined to Scotland, 1758. 353 

over the body, which lasted two or three days, or longer, and 
then went off in some by a critical sweat. In the October out- 
break it affected children mostly. Once more, in 1757, the same 
catarrhous fever returned, with almost the same circumstances \ 
That year there was a universal catarrh in North America. 

Not less remarkable than the epidemic catarrhal fever in 
Minorca in 1748, or those in Barbados in 1752-3, 1755 and 1757, 
was the epidemic of 1758 in Scotland^ It was first noticed 
with east winds from the i6th to 20th September, several 
children having taken fever like a cold. In the last week of 
September thirty out of sixty boys at the Grammar School of 
Dalkeith were seized with it in two or three days. In October 
it became more general, among old and young, and increased 
till about the 24th, when it began to abate. In Edinburgh not 
one in six or seven escaped. It was in most parts of Scotland 
in October — Kirkaldy, St Andrews, Perthshire (where many died 
of it), Ayrshire, Glasgow, Aberdeenshire, Rossshire (end of 
October). A gentleman told Dr Whytt that in the Carse of 
Gowrie, in September, " before this disease was perceived, the 
horses were observed to be more than usually affected with a 
cold and a cough." 

The symptoms in Scotland were of the Protean kind of 
" influenza " : there might be fever with no cold ; or a coryzal 
attack with little or no fever ; or some had bleeding at the nose 
for several days, which might be profuse ; or the soreness and 
pains in the bones might be in all parts of the body, or confined 
to the cheekbones, teeth and sides of the head. Others had 
a fever without any distinctive concomitant, but a cough when 
the fever subsided''. One of Whytt's patients, a lady aged 
thirty, had been feverish for four days, when a scarlet rash 

^ W. Hillary, M.D., Obs. on...Epid. Diseases in Barbadoes. Lond. 1760. 

^ It is not described for England, unless a reference by Bisset for Cleveland, 
Yorkshire, should apply to it. Short says, under the year 1758 {Increase and Decrease 
of Mankind in England, 6^r. 1767) : A healthy year in general, " only in the harvest 
was a very sickly mortal time among the poor, of a putrid slow fever, which carried 
off many. An epidemic catarrh broke out in November, and made a sudden sweep 
over the whole kingdom." Barker, of Coleshill, says, in his Putrid Constitntion of 
1777 (Birmingham, 1779, p. 49): "In the remarkable intermittents of 1758 or 9... 
the early and consequently injudicious use of the bark was attended with such fatal 
effects that a few doses only sometimes totally oppressed the head, brought on a most 
rapid delirium, and cut off persons in half-an-hour." 

* Robert Whytt, M.D., "On the Epidemic Disorder of 1758 in Edinburgh and 
other parts of the South of Scotland." Med. Obs. and Ing. by a Society of Physicians, 
6 vols. Lond. ii. (1762), p. 187. With notices by Millar, of Kelso, and Alves, of 
Inverness. 

C. II. 23 



354 Influenzas and Epidemic Agues. 

appeared, but did not come fully out ; the fall of the pulse and 
fever coincided with the beginning of a troublesome tickling 
cough, "so that the cough might be said to have been truly 
critical." Those who exposed themselves too soon frequently 
relapsed. Few died of the disease, except some old people. 
" In some parts of the country, when the disease was not taken 
care of in the beginning, as being attended with no alarming 
symptoms, it assumed the form of a slow fever, which sometimes 
proved mortal." 

The year after the localised influenza of Scotland there was 
an epidemic of the same kind in Peru and Bolivia, that year, 
1759, being one in which no universal fever or catarrh is reported 
from any other country. It extended from south to north, 
along the coast as well as over the high table-lands of Bolivia 
and the sierra region of Peru, invading, among others, the 
populous towns of Chuquisaca, Potosi, La Paz, Cuzco and Lima. 
In five or six days hardly one inhabitant of a place had escaped 
it, although some had it very slightly. As it was swift in its 
attack, so it was soon over, lasting about a month in each place. 
Its symptoms were great dizziness and heaviness of the head 
(vertigo and gravedo), feebleness of all the senses, deafness, 
strong pains over all the body, moderate fever, weariness, great 
prostration, complete loss of appetite, bleeding from the mouth 
and nostrils (this had been noted in Scotland the year before), 
and a long convalescence. Dogs shared the disorder, and 
might have been seen lying stretched out in the streets, unable 
to stand. It will be observed that the symptoms given do not 
include catarrhs 

Before we come to the next general influenza in Britain, that 
of 1762, there are some facts to be mentioned as to agues and 
horse-colds in the interval since 1743. In Rutty's Dublin 
chronology, agues are entered as prevalent in 1745. In 1750, 
about the middle or end of December, the most epidemic and 
universally spreading disease among horses that anyone living 
remembered made its appearance in Dublin, and in Ulster and 
Munster almost as soon. It had been in England in November, 
and was like that which preceded the universal catarrhs of 
mankind in 1737 and 1743. In 175 1, irregular agues were 

^ Archibald Smith, M.D., "Notices of the Epidemics of 1719-20 and 1759 in 
Peru," &c. from the Medical Gazette of Lima, on the authority of Don Antonio de 
Ulloa. Trans. Epic/. Soc 11. pt. i, p. 134. 



Tnflttenza in horses, especially in 1760. 355 

frequent in March, as were also tumours of the face, jaws and 
throat. Agues also continued to be frequent in April, both in 
Dublin and in several parts of the country. In December, 
175 1, and January, 1752, there was another horse-cold, the same 
as a twelvemonth before. In 1754 the spring agues were 
frequent in Kilkenny and Carlow, though rare in Dublin. In 
1757, "intermittent fevers, which had not appeared since April, 
1746," came in the end of February. In 1760, a great catarrh 
among horses became general in Dublin in April, Coughs and 
tumours about the fauces and throat, with a slight fever, often 
occurred in March ; and regular intermittents, tertians or quoti- 
dians, were more frequent than for some years past. These, 
according to Sims, of Tyrone, abated after 1762, so that he had 
not seen an intermittent since 1764 until the date of his writing, 

1773- 

The horse-cold of 1760 was observed in London in January, 
The Annual Register says under date 27 Jan. : "A distemper 
which rages amongst horses makes great havock in and about 
town. Near a hundred died in one week." In a letter a day 
later (28 Jan.) Horace Walpole writes : "All the horses in town 
are laid up with sore throats and colds, and are so hoarse you 
cannot hear them speak....! have had a nervous fever these six 
or seven weeks every night, and have taken bark enough to 
have made a rind for Daphne^" This same horse-cold is 
reported from the Cleveland district of Yorkshire : " In February, 
[1760] horses were invaded by the most epidemic cold or 
catarrh that has ever happened in the remembrance of the 
oldest men living^." The same authority for Cleveland says 
that intermittents were frequent and obstinate in the spring 
of 1760. 

Among these miscellanies of the history may be mentioned 
an outbreak of " violent pleuritic fever or peripneumene " in the 
spring of 1747, which was fatal to a comparatively large number 
in the parish of George Ham, North Devon. Thirteen died 
of it from the 20th to the 31st March, four in April, four in May, 
and one in June, " most of them in four or five days after the 
first seizure." The same family names recur in the list^ 

1 Hoi-ace Walpole's Letters, ed. Cunningham, iii. 281. 

^ C. Bisset, Essay on the Medical Constittition of Great Britain, i Jan. 1758, to 
Midsmnmer 1760. Lond. 1762, p. 279. 

"^ Extract from the parish register printed by Dr G. B. Longstaff in an appendix 
to his Studies in Statistics. Lond. 1891, p. 443. 

23—2 



356 Influenzas and Epidemic Agues. 



The Influenza of 1762. 

The universal slight fever or catarrhal fever of 1762 was, 
in London, much less mortal than those of 1733 and 1743. 



London 


Weekly Mortalities. 




1762 




Week ending 


Fevers 


All causes 


May 4 
II 


72 
104 


467 
626 


18 

25 


1 59 
162 


750 
659 


June I 


121 


516 


8 


85 


504 



It began in London about the 4th of April, and by the 24th 
of that month " pervaded the whole city far and wide, scarcely 
sparing anyone." It was in Edinburgh by the beginning of 
May, and in Dublin about the same time, but did not reach 
some parts of Cumberland until the end of June. Short, who 
was then living at Rotherham, says that it " continued most 
of the summer\" It had the usual variety of symptoms in the 
individual cases, of which only a few need be again particularized. 
Where the fever was sharp, it usually remitted during the day, 
having its exacerbation in the night. Sometimes it proved 
periodical, and of the tertian type : " it usually returned every 
night with an aggravation of the feverish symptoms " (Rutty). 
Perspiration was a constant symptom ; the tongue was as if 
covered with cream (Baker repeats this figure of Huxham's in 
1743)- "Depression of mind and failure of strength were in all 
cases much greater than was proportionate to the amount of 
disease. A great number of those affected were very slowly 
restored to health, languishing for months, and some even for a 
whole year with cough and feverishness— relics of the disease 
which it was diflficult to shake off. Some, after struggling long 
with impaired health, fell victims to pulmonary consumption. 
In some there were pains in all the joints and in the head, with 
lassitude and vehement fever, but with little signs of catarrh." 
Rutty, of Dublin, says that in some a measly efflorescence or 
a red rash was seen, attended by violent itching^ Among 

^ Increase and Decrease of Mankind ill Eni^land ^c. London, 1767. 
'^ Rutty, op. cit. p. 275. Compare Watson, szipj-a, p. 351. 



I 



The general hifluenza 0/1^62. 357 

labourers in the country, the pestilence was so violent as to 
destroy many within four days, from complications of pneu- 
monia, pleurisy and angina. Sometimes it took the form of 
a slow fever, " and approximated to that form of malady which 
the ancients denominated ' cardiac' ^" 

The mortality is said to have varied much. White, of 
Manchester, declared that fewer died there than in ordinary 
while the epidemic lasted. On the other hand Offley, of 
Norwich, said there were more victims there than by the 
epidemic of 1733 "or by the more severe visitation called 
influenza in 1743 " — the two visitations which were incomparably 
the worst in the whole history, according- to the London bills. 
Baker says that it infested cities and the larger towns crowded 
with inhabitants earlier than the surrounding villages, and is 
inclined to think that it was mostly brought by persons coming 
from London I 

The progress of this epidemic over Europe had been 
peculiar. It was seen in the end of February, 1762, at Breslau, 
where the deaths rose from 30 or 40 in a week to 150. It was 
in Vienna at the end of March, and in North Germany about 
the same time as in England — April and May. There were at 
that time British troops in Bremen, among whom the epidemic 
appeared shortly after the loth April*. 

" It looked at first as if they were going to have agues, but soon they were 
attacked with a cough and a difficuky of breathing and pain of the breast, 
with a headache, and pains all over the body, especially in the limbs. The 
first nights they commonly had profuse sweats. In several it had the 
appearance of a remitting fever for the two or three first days." The cough 
in many was convulsive. The epidemic seized most of the people in the 
town of Bremen : very few of the British escaped, but none of them died, 
except one or two, from a complication of drunkenness and pneumonia. 

It is said to have been nowhere in France except in 
Strasburg and the rest of Alsace, in June. Baker says, " Whilst 

^ G. Baker, De Catarrho et de Dysenteria Londinensi epidemicis, 1762, Lond. 
1764; W. Watson, "Some remarks upon the Catarrhal Disorder which was very 
frequent in London in May 1762, and upon the Dysentery which prevailed in the 
following autumn." Phil. Trans. Lii. (E762), p. 646. 

^ Professor Alexander Monro, primus, of Edinburgh, describes his own attack in a 
letter to his son, Dr Donald Monro, 11 June, 1766 {Works of Alex. Monro, M.D. with 
Life, Edin. 1781, p. 306): "My case is this: in May, 1762, I had the epidemic in- 
fluenza, which affected principally the parts in the pelvis ; for I had a difficulty and 
sharp pain in making water and going to stool. My belly has never since been in a 
regular way, passing sometimes for several days nothing but bloody mucus, and that 
with considerable tenesmus " &c. Dysentery was epidemic in 1 762 as well as influenza. 

■* Donald Monro, M.D., Diseases of the British Military Hospitals in Germany, cSr'c. 
Lond. 1764, p. 137. 



358 Influenzas and Epidemic Agites. 

it raged everywhere else, it did not reach Paris or its vicinity, a 
fact which I learned from trustworthy persons," On board 
British ships of war in the Mediterranean it occurred in July. 
Its severity appears to have varied greatly in different cities of 
the same country. Rutty, for Ireland, agrees with Baker, for 
England, that it was more fatal in the country than in the 
towns. 



The Influenza of 1767. 

The next influenza, that of 1767, was so unimportant that its 
existence in England would hardly have been known but for 
Dr Heberden's paper, " The Epidemical Cold in June and July 
I767\" Those few who were affected by a cold in London early 
in June observed that it differed from a common cold, and 
resembled the epidemical cold of the year 1762, on account 
of the great languor, feverishness, and loss of appetite. It 
became more common, was at its height in the last week of June 
or beginning of July, and before the end of July had entirely 
ceased. It was less epidemical and far less dangerous than the 
cold of 1762, so much so that the London bills of mortality 
hardly witness at all to its existence. The attack began with 
several chills ; then came a troublesome and almost unceasing 
cough, very acute pains in the head, back, and abdomen under 
the left ribs, occasioning want of sleep. Many of the symptoms 
hung upon several for at least a week, and sometimes lasted a 
month. The fever might be great enough to bring on delirious- 
ness, yet had plain remissions and intermissions. The same 
disorder was reported to be common about the same time in 
many other parts of England, and more fatal than it was in 
London. Heberden did not anticipate from it the lingering 
effects in the individual, for months or years, which marked so 
many of the cases in 1762". 

^ Med. Trans. piihUshed by the College of Physicians in London, i. 437. Heber- 
den's paper was read at the College, Aug. 11, 1767. 

- The nearest approach to Heberden's London influenza of 1767 is an epidemic' 
that Sims observed in Tyrone in the autumn of 1767 ; a season remarkable for 
measles and acute rheumatism. At the same time that the acute rheumatism 
prevailed, a fever showed itself, like it ; the patients for two or three days were 
languid, chilly, with pains in the bones, headache, stupor, dry tongue, costiveness. 
It was marked by remissions, was by no means mortal, and usually ended by a sweat 
from the 14th to the 17th clay, followed by a copious deposit in the urine. James 
Sims, Obs. on Epidemic Disorders, Lond. 1773, p. 84. 



Protracted zvinter Influenza of lyy^. 359 



The Influenza of 1775. 

Heberden invited physicians in the provinces to send in 
accounts of the epidemic of June and July. 1767, but no one 
seems to have responded. However, the next epidemic catarrh, 
of November and December, 1775, was made the subject of 
many communications from all parts of Britain, in response to a 
circular drawn up by Dr John Fothergill, This was a distinctly 
catarrhal epidemic, running of the nose and eyes, cough and (or) 
diarrhoea, being commonly noted. 

At Northampton some had " a severe pain in one side of the 
face, affecting the teeth and ears, and returning periodically at 
certain hours in the evening, or about midnight, attended with 
vertigo, delirium and limpid urine during the exacerbation. 
Some whose cases were complicated with the above symptoms 
had a general rash, but without its proving critical.., Many 
of those who escaped the catarrh have been more or less 
sensible of giddiness, or pains in the head or face," with limpid 
urine, etc., as if they had a full attack^ The epidemic began in 
London about the 20th October, and made a slight impression 
upon the bills of mortality in some weeks of November and 
December^ Grant says that it lasted nearly five months in 
London, having been attended by the same "comatose" fever 
which Sydenham associated with the epidemic catarrh of 1675. 
The fatalities in Grant's practice occurred late in the epidemic : 

"On the 23rd December [1775] I had lost one patient, and soon after 
two others ; all died comatous, owing, as I then imagined, to the remains of 
the comatose fever of Sydenham, which had raged all the autumn, was 
complicated with the catarrhous fever, and continued by the wet, warm 
uncommon weather for the season of the year; and I still [1782] am of 
opinion that this complication is the reason why the epidemic catarrh of 
1775 proved much more fatal than it did in 1782 — a fact known to all of us^.' 

^ Anthony Fothergill, Aleiii. Med. Soc. in. 30. This paper is not included in 
John Fothergill's series. There is also a separate Dublin essay, Advice to the People 
upon the Epide77iic Catarrhal Fever of Oct. Nov. Dec. 1775. By a Physician. 

^ I have not found the weekly bills for this year in London ; but the following 
averages, taken from the four-weekly or five-weekly totals in the Gentleman' s 
Magazine, will show how slight the rise was : 

1775. October weekly average 323 births 345 deaths 
November „ „ 334 ,, 447 ,, 

December ,, ,, 369 ,, 449 ,, 

^ W. Grant, M.D., Observations on the late Influenza as it appeared at London in 
1775 and 1782. Lond. 1782. Also, by the same, A Short Account of the Present 
Epidejnic Cough and Feiier^ in a letter Qr'c. First printed at Bath, and afterwards at 
London, 1776. 



360 Influenzas and Epidemic Agnes. 

A Liverpool writer also says that the catarrh of 1782 
"distinguished by the same title," was a much slighter complaint 
than the "influenza" of 1775. The latter, however, was a 
summer epidemic, and was naturally less complicated with 
pneumonia and bronchitis, whatever the " comatose " fever of 
1775 may have been. Grant's statement that the influenza of 
1775 lasted five months in London is borne out by the Foundling 
Hospital records: on 11 November, there were 16 in the In- 
firmary with " epidemic fever and cough," next week 22 with 
" fevers, coughs and colds," and so on week by week under the 
same names until the 9th of March, 1776^ At Dorchester it 
was general after loth November ; about the same time it was in 
Exeter, where within a week it seized all the inmates, but two 
children, in the Devon and Exeter Hospital, to the number of 
173 persons. The middle of November is also the date of its 
decided outbreak at Birmingham, at Worcester, and at Chester, 
where Howard found the prisoners suffering from it. At York 
in the north, as at Blandford in the south, it is claimed to have 
begun earlier than in London. At Lancaster it was not seen 
until three weeks after the accounts of its prevalence in London 
began to come in, but only three days after it was first heard of in 
Liverpool. At Aberdeen it was fully a month later than in 
London. It did not visit Fraserburgh, though there was a putrid 
fever there very fatal at that time^ 

In many cases the disease assumed the type of an inter- 
mittent towards its decline, but bark was not useful (Fothergi